The Assembly met at 10.30 am (Mr Speaker in the Chair).
Members observed two minutes’ silence.

December Monitoring

Mr Speaker: I have received notice from the Minister of Finance and Personnel that he wishes to make a statement on the December monitoring round.

Dr Sean Farren: On behalf of the Executive, I wish to make a statement on public spending allocations in 2001-02 following the December monitoring round.
At their meeting on 18 January 2002, the Executive decided on some reallocations of expenditure for the short time that remains in the financial year. Those reallocations make use of the resources available from changes in the estimated requirements of Departments that emerged in the December monitoring round.
The Programme for Government has guided our prioritisation of the allocations. Inevitably at this late stage of the year, however, our focus has been on making necessary changes to estimated requirements and fine-tuning allocations, rather than on any policy changes or new priorities.
The December monitoring round completes the process of considering what revisions might be necessary or desirable to amend Estimates provision in the current year. The process for the passage of the first Budget Bill, which addresses the spring Supplementary Estimates for all Departments, must begin now.
This monitoring round is governed by the timetable for the first Budget Bill, which is tight every year. All the stages of Assembly consideration of the spring Supplementary Estimates and the Budget Bill must be completed in time to secure Royal Assent before the end of the financial year, yet we cannot realistically begin this process any earlier than mid-December, as we must take account of the latest information on spending plans from Departments.
Some reallocations are possible later through the February monitoring round, but those are constrained by the ceilings set in the Estimates, which rule out any large-scale switches between Departments. Therefore the issues addressed in this monitoring round will be the last that can be reflected in Supplementary Estimates for this financial year.
The amount available for reallocation is £73 million. Once again there are several reasons for the amount’s being so high at this stage of the financial year. We would normally expect to have a substantial amount, but several factors have yielded substantial resources for reallocation now.
The Department of Agriculture and Rural Development surrendered £12·5 million primarily because of the impact of the foot-and-mouth disease outbreak, which disrupted planned activity and delayed the obtaining of European Union approval for certain programmes.
The Department of Education needs £13 million less than planned for threshold payments to teachers following the teachers’ pay settlement agreed last January. Against this reduction in the estimated accruals cost of the threshold payments, the Department will face a pressure of £5·5 million in 2002-03, and I will return to that later.
The Department of Employment and Learning identified several easements amounting to £12·7 million, most notably in its New Deal and Jobskills programmes.
The Department of Enterprise, Trade and Investment can surrender a net £8·6 million from industrial development grants and capital receipts after allowing for the reallocation of funds to meet a number of inescapable contractual obligations in other aspects of assistance to industry.
Elsewhere several Departments have identified a range of additional receipts from fees and charges and disposal of assets.
Before I refer to the bids received, I will point out issues affecting 2002-03, as they relate to the approach the Executive have agreed for this monitoring round.
The revised Budget for 2002-03 was constructed on the basis that we could, without undue risk, allocate some £40 million of spending power for planned carry- forward into 2002-03 from anticipated underspending this year and also set aside £8 million of that anticipated underspending to meet urgent pressures in the Health Service. This latter allocation to health is shown in the table of allocations in the annex to my statement, as it has to be funded from the spending power available now.
In proposing this approach in September, my predecessor, Mark Durkan, made it clear that it would be possible to manage resources in the September and December monitoring rounds, and also during 2002-03, and to make good these assumptions. I am pleased to report that we are now in a position to confirm this by adding £5·7 million from the resources now available to us to the £21·3 million we set aside in the September round. This leaves a balance of £13 million to be found in the February monitoring round.
In taking this approach, the Executive have considered carefully the need to address positively the difficulties which the Health Service is currently facing.
However, we also need to be realistic about the amount that can be spent in this financial year. In other words, we need to strike a balance between ensuring that we are responding to immediate problems in the short term and making sure that our longer-term spending plans for next year are properly resourced.
Departments lodged bids for additional resources in this monitoring round totalling over £98 million. The majority of those bids represent changes in estimates of requirements since the Budget for 2001-02 was approved in December 2000. Some have arisen from the need to address new cost pressures. It is not surprising that the bids are smaller than would be the case at other stages, given that there are only a few months remaining in this year.
Given the substantial amounts available, the Executive have decided to meet a very large proportion of these bids, amounting to some £59 million. Together with the £8 million already allocated to health and the £5·7 million needed to complete the planned carry-over for 2002-03, they account for the total resources of £73 million available.
I will say a little about the additional allocations for each Department. The Department of Agriculture and Rural Development will receive an additional £9·8 million, £7·1 million of which is to meet the additional costs of compensation allowances arising from animal disease, mainly brucellosis and tuberculosis. Provision has also been made for some further costs arising from the foot-and-mouth disease crisis and BSE.
The Department of Culture, Arts and Leisure will receive funding to assist smaller museums and will retain receipts from the sale of some surplus property to undertake pressing maintenance work within the public library estate.
In the September monitoring round, Mark Durkan announced that the Executive had agreed to set aside £1·9 million for the deficit in funding for the Museums and Galleries of Northern Ireland (MAGNI), subject to an examination of the circumstances and factors which gave rise to this deficit. The sum of £1·1 million represents an accumulated deficit in recurrent funding, and the Executive have agreed to confirm the allocation of resources to that, subject to MAGNI and the Department of Culture, Arts and Leisure agreeing a recovery plan with my Department and the Economic Policy Unit in the Office of the First Minister and the Deputy First Minister to secure cost savings and greater financial stability. This could involve re-examining the scope for rationalisation and centralisation of support services to see if the economies assumed when the merger of the three previous organisations was approved will be realised.
The balance of £0·8 million is needed for maintenance work at the museums. The Executive have agreed that we should confirm £0·5 million of this because some of the work needed is health and safety related and particularly urgent. However, the balance of £0·3 million will now be used for other purposes and has been taken into account in the allocations I am announcing today.
The Department of Education is receiving funding for the education element of the north Belfast initiative. This will address the needs of schools and young people in north Belfast and help rebuild community relations. The Youth Service is also receiving funding, primarily to address health and safety issues and to meet urgent equipment needs.
As I said earlier, the Department of Education has also bid for £5·5 million to enable the cost of threshold payments to teachers to be fully met in 2002-03. It has surrendered £13 million in the current year in respect of the same payments. This is largely a technical issue, and we have agreed that it is not necessary to set aside money for this purpose now as there is time for this to be covered from the February monitoring round or from routine end-year flexibility. However, to enable the Department to plan on a firm basis, we have given a commitment that funding for these payments will be allocated in 2002-03. This is a further example of how we are ensuring that in-year resources are being targeted at current priorities and pressures and minimising the amount of planned carry-over into next year.
The Department for Employment and Learning is receiving an allocation of £3·3 million. This will be used mainly to meet the needs of the learndirect network following the closure of individual learning accounts. It will also provide an advance grant to the Lisburn Institute to overcome difficulties there.
The Local Enterprise Development Unit (LEDU), in the Department of Enterprise, Trade and Investment is being provided with £2 million to meet projected client claims and fund two new programmes. Elsewhere, the Department is reallocating funding originally provided for industrial development grants to assist industry in other areas where some inescapable contractual obligations have arisen due partly to the world economic recession and the impact of 11 September.
There is also an allocation for the Department of Finance and Personnel to cover the initial procurement and implementation costs of accounting systems to support a common approach to the provision of accounting services across all Departments. This will be more economical than developing separate systems for all 11 Departments.
The Executive have, as always, paid particular attention to Health Service needs, and they are acutely aware of the pressures which are causing such deep concern across the community. In recognition of that, we have decided to allocate £7·8 million primarily to meet cost pressures in health and personal social services. This allocation is in addition to the £8 million which we had already agreed to allocate to the Health Service and which Mark Durkan announced on 3 December when he presented the revised Budget for 2002-03 to the Assembly. Provision for that is now being made in this monitoring round. Taken together, these allocations will enable urgent medical equipment to be purchased by trusts, and they will meet costs arising from higher-than-planned levels of service activity, junior doctors’ contracts and consultants’ payments, as well as address pressures in pharmacies, laboratories and domiciliary care. They will also cover a shortfall in trusts’ projected income from GP fundholders.
The funding will be of real and immediate benefit to those in need of treatment and care, but many people will ask why we are not doing more, especially when we have seen so vividly the scale of the problems being faced in some acute hospitals. At this late stage in the financial year only limited amounts of additional funding can usefully be directed towards addressing the most immediate pressures. The Executive have looked carefully at this and listened carefully to advice from the Minister, Ms de Brún. We need to understand better the reasons for the underlying problems in the Health Service, and we need to develop appropriate strategies to address them.
While we need to respond to the particular difficulties that we are now facing, we must also actively seek long-term solutions rather than quick fixes.
The Department of the Environment is being allocated funding to meet the costs of producing the Belfast metropolitan area plan. It has also been necessary to add £14 million to the Department for Regional Development’s budget to meet a range of unavoidable cost pressures in public transport and in the Roads Service and the Water Service.
The Department for Social Development is being allocated £4·9 million to meet a range of pressures — most notably to cover a projected £3 million increase in applications for the special purchase of evacuated dwellings (SPED) scheme arising from recent increases in civil disturbances. This provides more tangible evidence of the financial and social cost, which is a direct consequence of the unrest that affects so many in our community.
These are costs that we must meet. However, I am sure that Members agree that it is deeply regrettable that we should have to do so when there are so many pressing needs in our public services, especially in health, education and transport. To complete the allocations, an additional £0·4 million is being provided to the Office of the First Minister and the Deputy First Minister.
As I explained earlier, these allocations largely represent the fine-tuning of estimated requirements across Departments. They are routine reallocations of spending power to move resources from where they are no longer needed, or cannot now be spent, to the emerging pressure points across departmental budgets.
I would like to raise another issue. Several Departments submitted bids in this monitoring round — totalling more than £4·5 million — for interim funding of projects that will be seeking funding from the Peace II programme. To ensure that Departments had some latitude in judging what would and would not succeed under Peace II, the Executive had previously agreed to set aside £2 million from the Social Inclusion /Community Regeneration Executive programme fund to cover any costs that were met in good faith, but which in the end proved not to be recoverable from the Peace II programme.
However, Departments are now seeking resources over and above the £2 million currently available, which would be needed only if it transpires that the commitments they have made are not successful under Peace II. These bids are being carefully assessed to determine how much is likely to be required from our own Budget. However, the position is not clear at present, and the Executive have concluded that it would be prudent to make further provision to cover projects that have been funded by Departments in good faith, but which may not be funded under Peace II. Therefore we have set aside a further £2 million from the Social Inclusion/Community Regeneration Executive programme fund for that purpose. This will leave much less for new projects from that fund in 2002-03.
We will be able to review the position when the gap funding issue has been concluded and Peace II is fully operational. In agreeing this provision, I emphasise that Departments will receive allocations for gap funding only if they can show that the projects could reasonably have been expected to succeed under Peace II; this is not an open door for bids for general support to the voluntary sector.
I recognise that some projects will no longer receive funding. Those projects will have to seek financial support from other sources. Indeed, it was made clear under Peace I that projects should be one-off, stand-alone projects or that they should develop an appropriate exit strategy. Through the introduction of gap funding, the Executive have made every effort to smooth the transition to Peace II funding and provide a soft landing for projects that are not successful in receiving funding from Peace II. Future calls for funding will now have to be handled through the usual channels.
This monitoring round has provided some significant adjustments to expenditure patterns in this financial year. I stress that these are mainly routine adjustments, driven by revised estimates of requirements up, down and across a wide range of services. Members will ask why this round has continued the recent trend by yielding a large, though welcome, amount of room for manoeuvre. I expect the Assembly to question the effectiveness of our financial planning and estimating and to raise concerns about the level of resources being surrendered at a time when so many public services are facing real problems.
The Executive share this concern and have agreed that some analysis should be made to identify whether there are any underlying causes for this pattern of underspending. With the benefit of that analysis, we will consider how best to address those underlying causes as we set spending plans for the period 2003-04 to 2005-06 later this year.
We must seek to improve our planning and estimating. It would also be desirable, and generally welcome, for Departments to have firm, longer-term spending allocations, which would enable pressures to be more easily addressed through effective management and re-prioritisation of resources.
As a first step we need to ensure that our resources are allocated to the areas of greatest need, and we will be seeking to make further progress towards that goal in the forthcoming spending review. Our work on needs and effectiveness will be one element that will help to inform that process. The views of the Assembly and its Committees will also be an important influence on our thinking. However, we must be under no illusion: this will be an extremely challenging task, but one which we must address together if we are to fulfil our commitments and meet the expectations of the wider community.
In conclusion, the allocations I am announcing today on behalf of the Executive will provide real and immediate benefits to a wide range of our public services including health, education and transport. We have worked together to reach these decisions on the basis of a careful assessment of the most pressing priorities, and, in doing so, we have provided further evidence of our commitment to open, transparent and accountable Government.

Mr Francie Molloy: Go raibh maith agat, a Cheann Comhairle. I welcome the Minister’s statement to the Assembly on this the first of his monitoring rounds. The statement reflects the concerns of the Committee for Finance and Personnel about the extent of reallocations in each monitoring round, especially at this time of the year. Should priority areas such as health, education and transport not be receiving a larger proportion of the Budget, instead of so much going to some Departments that, subsequently, are not able to spend their allocations? If we are listening to the advice of Assembly and the Committees on priorities, the allocations should reflect that.
I welcome the Minister’s commitment to the analysis of the trend. Can he give us a clear commitment before the next Budget round that the process will be examined in detail so that we can see some of the benefits coming through?
Are all these allocations being monitored with regard to TSN moneys? There are question marks over some of the allocations and how the Departments allocate TSN moneys.

Dr Sean Farren: I thank the Chairperson of the Committee for his remarks. I assure him, as I attempted to do in my statement, that the underspends and surrenders that he referred to will receive the analysis that I promised. No matter how precise our planning may become, it is unlikely that every Budget bid that is determined in December will be met 12 months later, according to the exact terms under which the finance was allocated. There may always be overspends and underspends.
Underspends are welcome, because they make available finance, which can be reallocated to meet emerging or immediate pressures. I trust that Members appreciate that. Nonetheless, the scale of the surrenders, at face value, raises questions that I have committed the Department to address. Planning will be more precise as a result of the co-operation of the Committees — particularly the Committee for Finance and Personnel, whose advice we value in that regard. However, I doubt that we will ever reach 100% accuracy in planning.
All Departments are obliged to ensure that their expenditure conforms to the framework requirement to target the social need that they have identified.

Mr James Leslie: I welcome the Minister to his first monitoring round. I note from his remarks that, whereas he started with a surplus similar to that of the Durkan years, he intends to reduce it.
Further to his remarks about the need to examine our budgeting procedures to ensure that they are as stringent as possible, does the Minister agree that that will have a further implication for the Executive programme funds? When departmental budgets were first shaved to create the pool for the Executive programme funds, there were howls of anguish — particularly from the Benches to my right. However, the Departments have been able to implement their plans under the rearranged budgets. That implies that the Executive programme funds have fitted comfortably into the scheme of things, and that they have provided a useful extra area of initiative for the Executive. Will the Minister comment on that? Alternatively, is he concerned that, in practice, the Departments have dipped back into the Executive programme funds to balance the books when their budgets have run short?

Dr Sean Farren: As Members will appreciate, the Executive programme funds were established primarily to assist the development of new policies and programmes and to improve public services in accordance with the priorities that were agreed in the Programme for Government. Their aim is to help the Executive to break away from established patterns of spending and to develop local solutions to local problems that are cross-cutting, where possible. On the basis of that policy, which is echoed frequently inside and outside the Chamber, the Executive programme funds generally have been welcomed.
Last April, £146 million was allocated in the first monitoring round, which covered 62 projects. Several of the projects involved Departments working in partnership. In addition, £31 million was allocated for student support services. A further £39 million was announced in December. Several of those were cross-cutting proposals.
The Executive consider the programme funds to be an effective means of promoting cross-cutting work and supporting initiatives brought by a group of Ministers working together. The Executive have decided, at this early stage of their implementation, to carry out a short review of the existing arrangements in order to ensure that the funds are working to best effect in delivering the Executive’s commitments and priorities. The review is in progress. Department of Finance and Personnel officials are due to appear before the Committee for Finance and Personnel on 29 January 2002 to discuss the review.

Mrs Annie Courtney: I welcome the Minister to the Chamber on his first monitoring round. I acknowledge his efforts to ensure that those Departments that are most in need receive extra funding.
In his statement, the Minister indicated that the Department for Employment and Learning made a successful bid for £1 million to provide an advance grant to the Lisburn Institute of Further and Higher Education. Can the Minister outline the nature of that grant? Is he aware that the North West Institute of Further and Higher Education in Derry is facing financial pressures that threaten to disrupt its provision of community education services? Has a bid been made by the Department for Employment and Learning in respect of that institute?

Dr Sean Farren: By the end of the financial year a deficit of around £1·1 million will have been created as a result of the running costs of the Lisburn Institute of Further and Higher Education. The recovery plan designed to enable the institute to regain financial stability has been agreed with the Department for Employment and Learning. The grant will temporarily provide the resources that are needed to enable a plan to be implemented. The sum awarded will be recovered from the institute’s grant in instalments over the next eight years.
I am aware of difficulties at the North West Institute of Further and Higher Education, as is my Colleague, the Minister for Employment and Learning. Her Department has commissioned consultants to ascertain the reason for the deficit. They will report by the beginning of February. The Department for Employment and Learning will not submit a bid to the Department of Finance and Personnel unless it is supported by a full recovery plan from the institute. In the meantime the Department is providing the means with which the institute can address its immediate cash flow situation by advancing its monthly grant. I assure the Member that the situation at the North West Institute of Further and Higher Education is being monitored carefully and a recovery plan is anticipated.

Mr Seamus Close: I welcome the Minister to his new position, and I welcome his presentation on the December monitoring round. In particular, I welcome the sweetening pill of the advance grant to the Lisburn Institute of Further and Higher Education. Does the Minister agree that the current monitoring round is a recognition of the Executive’s failure to make proper estimates and to get their sums correct?
We have been operating for several years. In spite of that, something is seriously wrong, given that there is so much underspending while Departments remain under pressure to respond to the people’s needs. Nowhere is that more apparent than in the health sector.
The Department of Health, Social Services and Public Safety has been allocated £7·8 million in this monitoring round. If health is supposed to be our number one priority, why has animal health been allocated virtually the same amount of money? Moreover, the Department for Regional Development has been allocated around £14 million. Does the Minister agree that health is not an emerging pressure, but one that has existed for several years?
Budgeting, monitoring and estimating are being carried out in entirely the wrong way, because we are in the same position, year in, year out. Allocations that are made as a "quick fix", represent money badly spent. The Executive must get their sums and estimations correct. As we move towards resource accounting, the situation can only get worse unless something is done urgently to correct it.

Dr Sean Farren: I appreciate the Member’s barbs that go with his good wishes on my appointment as Minister.
Health was at the core of Mr Close’s points. I assure him that the bids made by the Department of Health, Social Services and Public Safety in this monitoring round have been met in full — [Interruption].

Mr Danny O'Connor: Hear, hear.

Dr Sean Farren: Until I looked around, I was unsure of how to receive that note of acclaim, but I accept it in the spirit in which it was expressed.
We have met the Minister’s bids. As I said, £8 million has been made available, in addition to the planned Budget allocations that my predecessor announced in December. Almost £16 million from the current monitoring round has been made available to health. Those moneys are designed to meet the pressures that are identified by that Department.
Seamus Close casts a keen eye over all budgeting announcements. I am sure that he is fully aware of the scale of additional investment that has been made in the health sector since devolution and that next year’s health allocation will be almost 10% higher than the current year’s allocation. We are aware of the Department of Health, Social Services and Public Safety’s needs and are responding to them as they are identified.
Longer-term issues are being addressed as part of the Department’s strategic approach. We await the requirements that will arise as a result of that, and we will respond to them accordingly. I addressed Mr Close’s general point about the associated budgeting and planning in my response to the Chairperson of the Committee for Finance and Personnel.
We are analysing the pattern of underspending. We must recognise that circumstances can give rise to unanticipated underspends. In the past year, for example, the foot-and-mouth crisis placed particular pressures in one direction. Certain programmes for which expenditure had been anticipated were either delayed or put back indefinitely as a result of the clampdown on agricultural activity that ensued from the outbreak of the disease.

Prof Monica McWilliams: I too welcome the Minister to his new portfolio. I was taken aback by the large sum of money that we now surrender under the technical term "easements". I cannot understand how matters related to non-recurrent funding have come to be classed as "bids". I also declare my disappointment that over £3 million has been allocated to fund animal tuberculosis compensation, given the scandal that was pointed out by the Northern Ireland Audit Office that, to date, £21 million has been handed out in compensation. There are many questions on what is happening here.
I have serious questions about the information presented today for the first time in the section "Bids Recommended". I am a member of two Assembly Committees, and I have not seen those bids until now. There may be an explanation for that. Under the heading "Centre" there is a recommended bid by the Department of Enterprise, Trade and Investment for Invest Northern Ireland and another by the Department of Health, Social Services and Public Safety for funding to provide medical equipment for trusts. That bid should have been scrutinised by the Committee for Health, Social Services and Public Safety. It should also have examined the £4·6 million bid for funding to meet hospital and community health pressures and the amount that it is planned to carry forward.
Much as I have tried, I see no explanation for those recommended bids. That is no way to run the Assembly. There may be some explanation, but Members saw those bids for the first time today, without having had any time to see the broader picture and understand the pressures involved.
I hope that some bids will be non-recurrent; for example, the bid for £3 million for the SPED scheme in respect of people who have been intimidated out of their homes. Let us hope that there will be no such bid in the next round.
I am concerned that the facility for Members’ scrutiny of those bids leaves much to be desired.

Dr Sean Farren: I thank the Member for her questions and comments. I did point out that at this time of year our timetable is tight, so all the scrutiny to which the Member suggests the Committees are entitled may not be possible. However, the Committees can always keep in touch with expenditure in their Departments. In that way they can make themselves aware of emerging pressures and underspends to enable them to forecast likely situations. The pressures communicated to us in mid-December emerged over time, not in the day or two before documents reached the Finance and Personnel Committee. The Executive Committees need to look carefully at how they address spending issues. They should seek from the Departments information in respect of anticipated underspends and emerging pressures throughout the year.
The timescale for December monitoring means that it is not possible to allow any more time. Perhaps we need to address that issue with the Committees to see if better use can be made of the time between the identification of the bids and the announcement of the decisions so that the information that the Member is seeking can be made more readily available. However, the period running up to the identification of bids and underspends must be looked at as well.
The allocation of £8 million to the Department of Health, Social Services and Public Safety was announced and approved in the Assembly in December 2001 as part of the Budget proposals.

Prof Monica McWilliams: On a point of order, Mr Speaker.

Mr Speaker: I do not normally take points of order during questions on ministerial statements. However, I sensed from the Member’s question that there was a query about the order and procedure of the Assembly. The proper context in which to take up the matter may be in discussions with the Chairperson of the Committee and myself, rather than with the Minister of Finance and Personnel. It may be that some of the Member’s questions are about information from Departments to Committees, rather than from the Department of Finance and Personnel to Committees. If that was the point of order, and if the Member wishes to raise the question with me directly, I will be happy to consider it.

Prof Monica McWilliams: Thank you, Mr Speaker.

Mr John Kelly: Go raibh maith agat, a Cheann Comhairle. I also welcome the Minister’s first address on the monitoring rounds. He said that underspends are welcome. However, the lack of explanation as to why these underspends arise is unwelcome. Therefore, I am glad to hear that the Minister will examine the pattern of underspends and whether the forecasting systems are effective in determining how those occur.
The Minister’s former Department, the Department for Employment and Learning, announced a remarkable underspend of £51 million. Departmental officials told the Committee for Employment and Learning that they had reduced the underspend to £13 million. Aspects of that underspend left the Committee with many questions about issues such as New Deal and student grants.
It is concerning to read that the Department for Employment and Learning is declaring only £13 million of those easements. "Easement" is a euphemism for carelessness or poor cost-effectiveness. Does the Minister know where the missing £38 million has gone? It is also concerning that there is no explanation of how the easements were reduced to £13 million.

Dr Sean Farren: I do not recall any underspend on the scale that the Member quoted. In the September monitoring round, the Department surrendered £10·6 million, and £6 million was surrendered in December. We are working on the basis of that information, and I accept that those are the real figures.
It is important, when considering services that are demand-led, to appreciate that the prediction of the scale of demand from one year to the next — forecasting in December what the scale of demand will be next September or October — is not an exact science.
We do not know, for example, how many students will be accepted into higher education, so we cannot determine precisely the pressures on that budget. We cannot predict accurately the number of people who will avail of services such as New Deal; the context is set by the number of unemployed people. Recently, the situation has been generally positive, as the number of unemployed people has dropped considerably. There has, therefore, been less pressure on services included in the New Deal programme. However, the situation could change dramatically. To an extent, the situation is already changing; recent figures show a regrettable increase in unemployment. Pressures on the services provided by the New Deal programme are likely to increase, and we must bear that in mind. The Member did not take account of the particularities of the situation. He needs to look beyond the figures to find an explanation for the underspending.
I echo the Member’s welcome of the underspending. Underspend in one Department leaves money to I echo the Member’s welcome of the underspending. Underspend in one Department leaves money to meet pressures in other Departments. That is the object of exercises such as the monitoring round.
(Mr Deputy Speaker [Mr McClelland] in the Chair)

Mr John Kelly: The question was not answered. The figure of £51 million that I quoted came from the Minister’s old Department.

Mr Donovan McClelland: If the Member wishes to pursue the matter, he may write to the Minister.

Dr Esmond Birnie: I thank the Minister for his statement. This is his first monitoring statement, so I join with those who wish him well with his new responsibilities.
The Minister will not be surprised that I wish to ask him about the part of his statement that relates to his former Department. In particular, I wish to ask about the so-called advance grant of £1 million that is being given to the Lisburn Institute of Further and Higher Education, although that has been mentioned several times this morning. Is the Minister concerned about the perceived unfairness to other further education colleges that have managed to avoid running up such deficits? Is he satisfied that the Department for Employment and Learning’s financial monitoring mechanisms are now sufficiently robust to detect colleges and further education colleges that get into financial deficit at a sufficiently early stage — before that deficit reaches £1 million, for example?
I was pleased to note the Minister’s response to the previous question. Again, there is a considerable easement in the spending on job programmes, such as New Deal and Jobskills, in the Department for Employment and Learning. This is partly, although not entirely, due to favourable labour market conditions. If unemployment rates are increasing with the effect that it is regrettably necessary to increase such spending again, the Committee for Employment and Learning hopes that the Minister will look favourably on these needs.

Dr Sean Farren: I thank the Member for his questions. I must resist the temptation to answer as if I were still the Minister for Employment and Learning. I have to satisfy myself, as Minister of Finance and Personnel, that the financial requirements on the Department are robust and meet the criteria tests with regard to public expenditure. I am satisfied that that is the case. It is therefore not my responsibility to answer questions about other unnamed colleges for which the Department for Employment and Learning has responsibility.
In this case, particular requirements have led the Department for Employment and Learning to make a bid on behalf of the Lisburn Institute, which has experienced pressures. As Minister of Finance and Personnel, I make recommendations to the Executive, and the Executive have agreed to provide those funds. I believe that the repayment requirements are justified and are part of the package that has been worked out between the Department and Lisburn Institute.
Dr Birnie has raised issues that other Members have also raised. All programmes within the Department for Employment and Learning, including those associated with New Deal and Jobskills, are demand-led, and the Department responds to the existing demands. When demands recede during the year, money then becomes available which had not been anticipated when the bids for those programmes were first made. It is appropriate that we reallocate those funds in the manner in which the monitoring round requires that we should. We should not point the finger at Departments and say that their planning was not what it should have been. However, we are examining the underspending patterns across Departments to see what lessons can be learnt and what advice can be given on budgetary planning.

Dr Joe Hendron: I congratulate the Minister on his new portfolio. I wish to return to a point that Monica McWilliams made earlier. She referred to the description of a Department as "Centre" on page 3 of the statement annex under "Bids Recommended". There is no Department of the Centre. There are references to "Trust Medical Equipment" and so on, which probably should be dealt with under the heading of the Department of Health, Social Services and Public Safety.
The Minister is aware of the massive pressures on the Health Service. Given that the reviews and consultations on acute hospital services, primary care, public health and community care have identified the need for restructuring and serious investment, can the Minister assure us that he, the First Minister, the Deputy First Minister and the rest of the Executive will listen carefully to the requests of the Minister of Health, Bairbre de Brún?

Dr Sean Farren: I can give that commitment. The commitment that is being sought is one from myself. However, I cannot speak on behalf of the Executive with respect to their general approach to business. Nonetheless, from my experience in the Executive, I would say that careful attention is paid to pressures identified by all Ministers.
The concerns expressed by Members of the House, by the health professions and by members of the public are re-echoed in the Executive’s deliberations on matters relating to the Department of Health, Social Services and Public Safety.
We are acutely aware of the pressures. When particular pressures are identified, to which we can respond with the resources available, we do so. The manner in which we have responded to the bids that have been submitted in this monitoring round demonstrates that, as does the additional money over and above that contained in the draft Budget that was identified and made available by my predecessor. The £8 million to which I refer was announced by Mr Durkan in December. To that we are adding almost £7·8 million. Therefore, a total of almost £16 million from the present monitoring round is available for health, which clearly indicates our concerns.
We wish to hear the longer-term strategy plans that the Minister will bring to my Department in the near future. Those plans will be considered in the generally sympathetic way in which the Executive have considered requests from the same Department since I have been a member of the Executive.

Ms Sue Ramsey: Go raibh maith agat. I agree with the Minister’s statement, which says, as a first step, that we need to ensure that resources are allocated to areas of greatest need. He also pointed out that the Executive are aware of the pressures facing the Health Service. Although I welcome any additional money, the £7·8 million mentioned is there only to meet costs that arise from service activity and junior doctors’ contracts.
In his statement, the Minister pointed out that there is a real and immediate benefit to those in need of treatment and care, and he expects that many will ask why we are not doing more. That is my first question. Why are the Minister and the Executive not doing more to meet the pressures in the Health Service? Health is a priority in the Programme for Government and for the Executive. However, slightly less than 10% of the allocated money is going to the Health Service, and that money is non-recurrent. Although I agree with the Minister’s previous answer, he did say that long-term planning is needed to tackle the Health Service’s problems. However, non-recurrent money does not allow for long-term planning. Does the Minister agree that that shows a need for an increase in the Department of Health, Social Services and Public Safety’s overall baseline figure?

Dr Sean Farren: Members need to appreciate the nature of the monitoring exercise and the response that is made to the bids. I have made the point at least once — perhaps more than once — that we have responded 100% to the Department of Health, Social Services and Public Safety’s bids in this particular monitoring round. We have responded positively to the needs and pressures drawn to our attention and the funding that is required to address them. We could not have responded more positively — we responded 100%, which is as positively as we can respond to any request.
At the risk of repeating myself, the Executive have been sympathetic to health. To make the point as clear as figures possibly can, since devolution, which covers the period from 1999-2000 through to 2001-02, we have agreed additional allocations of nearly £290 million to the health budget. Next year, health spending will be some £224 million, which is almost 10% higher than the provision for the current year.
Those figures represent significant additions and demonstrate the importance that we attach to this particular area. However, we must recognise that additional resources represent only part of the solution. We must ensure that allocated expenditure is used to the greatest possible effect.
Members will be aware that we are carrying out a needs and effectiveness evaluation of health and social care in order to better understand what we are achieving with what we are spending. Given the attention that has been paid to health and health-related issues — and that will continue this afternoon — Members will recognise that there are no easy answers. At the end of the day, we have to live within the overall Budget, and the additional funding for health and social care means that we may allocate less money than is being sought for other areas of public expenditure — but we are doing so in recognition of the particular pressures and requirements that come from this fundamental area of public life.

Mr Ken Robinson: I too welcome the Minister to his new responsibilities and congratulate him on the competent manner in which he presented his statement to the House.
How much of the allocation for the SPED scheme is targeted directly on the alleviation of distress in north Belfast? Does the statement represent the sum total of resources that are being targeted to that troubled area, or is there other money in the departmental budgets that is as yet unidentified? Does the Minister have a view on the likely amount of additional funding that may be required to address that fundamental problem?

Dr Sean Farren: Approximately £4 million has been allocated in this round to address issues arising from the situation in north Belfast. That comprises the cost of the package of measures announced by the First Minister and the Deputy First Minister on 3 December, additional work to the roads in the area and additional funding for the SPED scheme. That money could have been used to address pressures in the Health Service, for example. However, I am sure that the Members who represent the area will agree that it is important to recognise that the area is considerably disadvantaged. This spending will bring some additional benefits to the local community, particularly through the measures that address community safety, infrastructure and education.
The Budget provision for the SPED programme is £9 million, with expenditure to the end of November amounting to £8 million. To date there have been approximately 187 applications, and the anticipated expenditure is now £12 million. That additional provision will ensure that the Housing Executive can continue to assist those people who have been forced to evacuate their homes for security reasons, without taking resources from other areas.

Mr Joe Byrne: I particularly welcome the additional £14 million for public transport, roads and water. I also welcome the extra money allocated under Peace II for various categories of activity. Can the Minister confirm that some Peace II money will be allocated to gap funding for particular sustainable projects? How can the local strategy partnerships bid for extra Peace II money beyond their district council allocations from departmental money?

Dr Sean Farren: Gap funding does precisely what the name suggests — it deals with the needs of particular projects that are likely to benefit from Peace II funding. It is to help projects cross the gap between Peace I funding and Peace II funding with as little difficulty as possible. I pointed out that the allocations within additional resources set aside to meet such projects would have to be carefully scrutinised. It may well be that some projects that receive gap funding might not become eligible for funding under the Peace II programme. Therefore, as my statement indicated, gap funding will provide a soft landing for such projects.
As regards local strategy partnerships and the funding to be made available for projects under the measures for which they will have responsibility, concerns have been raised about the allocations that are being made under the determining formula. Additional funding is available under measures in Peace II other than those for which the local strategy partnerships are primarily responsible. Concerns have been raised particularly in rural areas, but these are not the only sources of support for the types of projects that it is hoped will be promoted in the overall context of the Peace II programme.

Mr David Ford: I also welcome the Minister to his new responsibility and wish him well. He has already clearly established that he must do his homework well when dealing with questions from my Colleague Mr Close. I trust that he will progressively improve his standards over the years.
He has already indicated one thing in answer to other questions — that it would be helpful if he were to publish a list of the bids received as well as those recommended. For example, it emerged only in cross- questioning this morning that the bids from the Department of Health, Social Services and Public Safety have been met in full. It would be interesting for Members to see a consolidated list, rather than the items that emerge only through individual Committees.
Secondly, on the issue of health, the Minister referred specifically to the need for longer-term solutions and not quick fixes. How is that position compatible with the fact that while additional hospital and community health pressures attracted £4·5 million, the Department for Regional Development appears to be getting almost £2 million just for salary increases and wages and inflationary pressures, all of which should have been entirely foreseeable at the start of the year? Why can a Department that is not supposed to be a priority get such a large amount compared with the Department that everybody in the Chamber acknowledges is the priority?

Dr Sean Farren: I return to the point that I have made on several occasions — we have met the bids that we were asked to meet. If you meet 100% of a bid you cannot go much beyond that. The Department of Finance and Personnel was asked for a certain amount of money, and we met the bid that was made. Issues relating to whether the Department should make a larger bid are matters that might be taken up by the Committee. It is not for me to answer for a Department as to why it made a particular bid.
That goes for any of the Departments for which the Executive have responsibility. The answer to Mr Ford’s first question is "Yes". We will put the information requested in Members’ pigeonholes later this afternoon.

Mr Derek Hussey: I welcome the Minister’s commitment to an examination of the monitoring system and how it will be affected in the future. The Speaker told Prof McWilliams that the Committees’ role in the submission of monitoring round bids might be looked at.
However, unlike Mr Close and, apparently, Mr Ford, I welcome the allocation to the Department for Regional Development — it is long overdue. Obviously Mr Ford and Mr Close do not understand the relationship between good roads that give accessibility to the rural population — [Interruption].

Mr David Ford: That is not what it — [Interruption].

Mr Donovan McClelland: Order.

Mr Derek Hussey: — in being able to reach facilities. They obviously do not understand the importance of clean water to good health. When you are getting a sound bite you obviously produce effluent; that has to be got rid of, and the Department for Regional Development takes care of that.
I am seeking the Minister’s insight on learndirect from his previous role in the Department for Employment and Learning. I understand that there are four district council areas where the network has not yet been established. Strabane is one of them, and my Colleague Mr Beggs reminds me that Larne is another. Can we, through the allocation being awarded, complete the learndirect network? With regard to local strategy partnerships and the areas that have been slightly underfunded previously, does the Minister not agree that many of the other measures are dependent on the district co-ordination that was afforded through the district partnerships and now through the local strategy partnerships?

Dr Sean Farren: Sorry, I was distracted. Would the Member please repeat the second question?

Mr Derek Hussey: With regard to the local strategy partnerships allocation and the reduction in some areas, will the Minister not admit that he has referred to the other measures whereby funding could be achieved, but the overarching district co-ordination of local strategy partnerships is important in ensuring that that funding can be accessed?

Dr Sean Farren: Learndirect is the responsibility of the Department for Employment and Learning. It is not in my remit to answer directly on the development of the learndirect centres. They were being rolled out when I had responsibility for that Department. It was anticipated that 30 or more would be in place during the year. It is more appropriate that my Colleague, the Minister for Employment and Learning, Carmel Hanna, should address issues related to the matters for which she has responsibility.
The involvement of the district councils and the social partners in local strategy partnerships should provide a role for those partnerships that would enable them to look at the general issues related to the development of the areas for which they have responsibility. While they may not have direct responsibility for allocations of other funding, the strategic role, which is captured in their title, would afford them the opportunity to look beyond the immediate allocations for which they have responsibility.
I recently stressed the expectation that those local strategy partnerships would outlast the Peace II funding period. I also stressed that there may be a role for them in a strategic planning and overview capacity beyond that period.

Mr Alban Maginness: I congratulate the Minister on his recent appointment and welcome his statement. I also welcome the increased allocation of almost £1 million to north Belfast, which demonstrates the Executive’s continued commitment to addressing the distressing situation in north Belfast. Will the Minister outline how that money is to be spent? I note the emphasis placed on rebuilding community relations.

Mr Donovan McClelland: Minister, I must ask you to be brief. We must finish on the hour.

Dr Sean Farren: The details of the bid recommended are that the Department of Education has been allocated £230,000 for the north Belfast package, and the Belfast Education and Library Board will receive an additional £265,000 in the February monitoring round; the Department for Regional Development has been allocated £300,000 for roads in the area; through the SPED scheme, the Department for Social Development has been allocated £3 million; and £150,000 has been allocated to the Office of the First Minister and the Deputy First Minister for the north Belfast package. That is how the total amount of £3·945 million will be spent departmentally.

Mr Danny O'Connor: On a point of order, Mr Deputy Speaker. Did the Speaker not rule that if a Member were not in the Chamber for a ministerial statement he would not be permitted to ask a question? A Member who was not present for Dr Farren’s statement was permitted to ask a question. Several Members asked multiple questions, yet other Members sat for an hour and a half without being able to ask their questions.

Mr Donovan McClelland: You are correct, Mr O’Connor. A note was made of the Members present when the Minister made his statement. In one case since I came into the Chair, a Member was allowed to ask a question because he was present for the major part of the Minister’s statement, and so some licence was granted. I am not aware of any other instance.

Mr Danny O'Connor: I refer to Mr Ford.

Mr Donovan McClelland: Thank you for that information, Mr O’Connor.

Mr Derek Hussey: On a point of order, Mr Deputy Speaker. Will Hansard be checked with regard to the Minister’s answer to my question? He said that because he was not the Minister responsible he could not provide an answer. However, the Minister earlier gave an answer to his party Colleague Mrs Courtney on a specific question about the North West Institute of Further and Higher Education.

Mr Donovan McClelland: The best way to elicit that information is to write directly to the Minister. We must move on.

Mr John Kelly: On a point of order, a LeasCheann Comhairle. Will the Minister’s civil servants read Hansard in order to address those questions that were not answered by the Minister today?

Mr Donovan McClelland: I have already said that if Members feel that a full answer was not given, they are free to write to the Minister.
12.00

Chaulnes Area

Dr Ian Adamson: I beg to move
That this Assembly notes the intention of the French Government to build a new airport in the area around Chaulnes in Picardy to serve Paris and requests the UK Government to consult closely with the French Government to ensure that due respect and honour are paid to the graves of those who gave their lives in the two world wars.
I thank my co-sponsors for tabling the motion. In June 1895 the last great Government in the Western World to exhibit all the characteristics of ancient aristocracy took office in England. For the most part they were great landowners and country gentlemen who regarded union with Ireland as sacrosanct and who proudly became the Unionist party to resist the attempts of Mr Gladstone to introduce home rule for Ireland.
They were extremely talented individuals. In that year the Marquis of Dufferin and Ava was British ambassador to Paris, and was well respected by the French. He wrote in his diary that besides reading 11 plays of Aristotle in Greek he had learned, by heart, 24,000 words from the Persian dictionary, 8,000 perfectly, 12,000 pretty well and 4,000 imperfectly.
In 1861 Lord Dufferin built the famous Helen’s Tower on his estate at Clandeboye outside Bangor, County Down. It was originally a gamekeeper’s residence constructed with the aid of labourers who were made destitute by the recent Great Famine in Ireland. It enshrines today the memory of Helen, the Dowager Lady Dufferin, author of ‘The Irish Emigrant’, who died in 1867 of breast cancer.
The tower is particularly beautiful, and it was immortalised by the great poets of the age. At the other end of the road that leads to it is the village of Conlig, where a little cottage stands in which William Sloan, my grandmother’s cousin, was born. At the age of 19 William joined the 11th Royal Irish Rifles. It became part of the 36th (Ulster) Division, which was formed from the Ulster Volunteer Force under extraordinary political circumstances.
The first world war stands like a searing scar across the face of human history. Time had stood still since the age of Moses and the patriarchs, but the great war was to change that and the whole world forever. Following the outbreak of the war, the British Army raised 82 battalions in Ireland by the end of 1914, of which Ulster contributed 42. Out of 145,000 voluntary recruits from Ireland, Ulster contributed approximately 75,000. No fewer than 46,000 recruits were from Belfast, which stood second on the roll of British cities for numbers of recruits in proportion to population until the imposition of universal service.
In addition to the famous 36th (Ulster) Division, there were six battalions of the regular Army from Ulster, five Ulster battalions from the 10th (Irish) Division and five more in the 16th (Irish) Division. Inspired by old family traditions, many Ulstermen chose to enlist in Scottish battalions such as the 6th Black Watch and 4th Seaforth Highlanders, who also had a recruiting office in Belfast. These formed part of the 51st (Highland) Division. Others joined the Argyll and Sutherland Highlanders. There were also many Ulstermen in the London Irish, the Church Lads’ battalion of the King’s Royal Rifles, the Bantam battalions and the Royal Scots, Cheshires and Sherwood Foresters. Besides the recruits from Ireland, many men who had been born in Ulster were to be found in the Dominion troops, especially among the Canadians, with whom two Ulstermen won the Victoria Cross.
The advance of the 36th (Ulster) Division at the commencement of the Battle of the Somme on 1 July 1916, when they sustained 5,500 casualties, is perhaps the most memorable single episode of the war, and it stands as one of the finest displays of human courage in the history of mankind.
Then, in September 1916, the 16th (Irish) Division entered the Somme battlefields with an equal display of courage at the battles of Guillemont and Ginchy. This division was mainly Nationalist in origin and included within its ranks many members of the National Volunteers, including 600 men of the Connaught Rangers from the Falls Road area of west Belfast, and B company of the 6th Royal Irish, which was composed exclusively of Derry Nationalists. In the first days of September it lost 200 out of 435 officers and 4,090 out of 10,410 men from other ranks among its infantry and engineer units. However, in doing so it gave Ireland a national character in Europe. It was the like of those men who made the Irish nation.
On the site of the advance of William and his comrades at Thiepval, a handsome memorial tower was erected by public subscription raised in the North of Ireland in memory of the officers, non-commissioned officers and men of the 36th (Ulster) Division, the sons of Ulster in other forces who died in the Great War and all their comrades-in-arms who were spared to return. The tower — modelled on Helen’s Tower at Clandeboye, where William and his comrades had trained near to his home — was opened on 19 November 1921 by Field Marshall Sir Henry Wilson, chief of the imperial general staff. On 1 July 1989, under the auspices of the Farset youth and community development programme, it was rededicated in the presence of HRH Princess Alice, Duchess of Gloucester. Veterans of the Great War, including the 36th (Ulster) Division, were accompanied to the ceremony by dignitaries and public representatives from throughout Northern Ireland, some of whom are present in the Chamber today. It is presently administered by the Somme Association, of which I am Chairman.
Every 1 July we go with the Somme Association, the Farset organisation, the Ulster Society and Thiepval Memorial LOL 1916 to visit Thiepval and the great memorial by Sir Edward Lutyens, on which William’s name is inscribed. On that day we commemorate the sacrifice of our loved ones who died for freedom. We do not seek to glorify war; rather we seek to see that it does not happen again.
To the mothers of Ulster we say "Mothers of Ulster, do not grieve, for your sons lie together with their former adversaries in the bosom of a proud and noble nation; they are not now solely the sons of Ulster, because they have also become the sons of France." To the sons of Ulster we say "Sons of Ulster, soldiers of Ireland, do not be anxious for we will never forget you."
Therefore it was with some anxiety that we learned that the French Government are planning to build a third airport in the Somme area about 130 km north of Paris to serve the city. The area of Chaulnes has been chosen for the airport, and there is speculation that the villages of Rosières, Vauvillers and Vermandovillers will be threatened, and with them the first world war British, French and German cemeteries in the area. However, the Commonwealth War Graves Commission tells us that this area was mainly a French area of operations in the Great War and that relatively few Commonwealth war graves could conceivably be affected. It is seeking further clarification from the authorities and will make strong representations to them should there be any proposal to disturb the graves. The French Government have, in the past, avoided the need to disturb war cemeteries when similar development has taken place. There is no reason to believe that they will act differently in this instance.
We understand from the French authorities that the perimeter of the final site is yet to be defined and that that is unlikely to be done until the end of February at the earliest. Before a final decision is made there will be consultations with all interested Governments, especially the British Government. The French Prime Minister, Lionel Jospin, has made a firm commitment on that. The French authorities say that they are anxious to respect and honour those who gave their lives for our common freedom. However, I have had numerous representations from worried constituents about this, and I hope that their fears will be unfounded.
One constituent raised the subject of the war grave in Belfast City Cemetery, where 350 memorial stones are currently in storage. That similar problem, though closer to home, also needs to be resolved.

Mr Donovan McClelland: A substantial number of Members have indicated their wish to speak in this debate. Therefore I must limit Members’ contributions to eight minutes each.

Mr Ken Robinson: I support the motion and trust that every Member will join me in doing so.
The events in France from 1914 to 1918 have touched the lives of all of us, irrespective of our political allegiance or aspirations. Anyone who has travelled through or lingered in the area between Paris and the Channel coast will have experienced the special aura that descends over that part of Picardy. The vast scale of the battles that raged with such ferocity in that area over 80 years ago is contrasted by the tranquillity of the graveyards which hold the remains of the men from the armies of France, Britain and their empires, as well as their opponents in the German ranks. Such was the scale of the slaughter and the impact on the survivors that the French Government granted the land containing war graves in perpetuity to "those who rest forever in this earth."
If the proposed airport to serve Paris is sited in Picardy, close to Chaulnes, Rosières-en-Santerre and Lihons, it will create environmental and ecological change and will impact on those who live there today. However, it will also set a precedent by which the displacement of war graves will become tolerable; then acceptable; then normal practice. Those who have not spent time in Picardy may be unaware that even today, human remains, cap badges, items of equipment, shrapnel and items of ordnance are still found in the corn fields or turned over by farmers’ ploughs in a grim annual harvest.
Any move to disrupt the tranquillity that pervades these last resting places must be opposed. The quest for a site for a new airport must proceed with the same sensitivity that accompanied the building of the high-speed TGV rail link between Paris and the Channel coast. If the site for a Paris airport were to lie across the mincer of Verdun, which is so central to the French psyche, I wonder what the reaction in that country might be? I trust that the French authorities will see how sensitive the graveyards of Picardy are to the British and Commonwealth psyche.
I will complete my appeal by reminding Members of the benefits that have accrued to our society through the largesse of the European Union, which is based on the desire of the French and the Germans never to repeat the carnage of two world wars. Surely it is fitting to ensure that such sacrifices are honoured in perpetuity. The French Ambassador in London, in reply to my recent letter, underlined that his Government are still open to consultation with the UK Government, among others, prior to a final decision being taken on the site for the new Paris airport.
There are eight potential sites for the airport. Given the air, road and rail traffic chaos that exists in the band between Paris and the Channel coast, surely the French Government will reconsider positioning an airport south of Paris. They once looked at the potential of an airport in the Chartres region; perhaps that idea should be revisited.
I urge the House unanimously to request that our Prime Minister and his Government consult closely with their French counterparts to prevent that precedent from being set. I remind Members that the war dead of many nations either lie in recognised graves, or appear on the rolls of honour to the missing. In many cases they still lie undiscovered in this sombre area. I read recently about Private Richard Clarke, who, 85 years after his death, was suddenly discovered and has now been laid to rest in an honourable grave.
I will share one or two recollections of my stay in the village of Authuile, which is beside the Thiepval monument that carries the names of hundreds of thousands of Allied dead who have no known graves. In the graveyard of Authuile lies the body of Willie McBride — the same Willie Mc Bride referred to in the haunting ballad "The Green Fields of France". In that cemetery, I met a young Dutch lady. She did not belong to the generation of either the first or second world wars. When I asked her why she was visiting that particular grave, she said that the words of the song had driven her to make a pilgrimage.
In those tear-jerking cemeteries in France there are posies of flowers placed by grandchildren who never knew their grandparents. The echoes of the war of 1914 and the more recent conflict from 1939 to 1945 still resonate throughout Europe and beyond. I ask that Members support the motion unanimously and to add their respect to the memory of the war dead.

Mr Danny O'Connor: I support the motion. I had the privilege of visiting the Somme area in July last year. As has been pointed out, the area still yields human remains. It could be said that the whole area is a cemetery and should therefore be treated with due respect.
I was nominated by my council to make that visit, and I went because my great-grandfather was killed in the Battle of the Somme. His name was John Stewart, and he was in the Argyll and Sutherland Highlanders. I logged on to the web site of the Commonwealth War Graves Commission. Unfortunately, I did not know my great-grandfather’s service number, but I knew his name and regiment. I found that 17 people called John Stewart from that regiment were killed in the conflict. That shows the scale and the horror of what happened.
Many people have hang-ups about going to the war cemeteries. They think that that war affects only one tradition. I visited the memorial at Thiepval and the memorial to the Irish Divisions at Guillemont. Like Mr Ken Robinson, I visited Authuile Military Cemetery. The area should be kept in a manner that shows respect for those who gave their lives in both world wars. When I went there I was shocked. I thought that the trenches would be hundreds of yards apart. However, at Vimy Ridge, where the Canadians fought — many of whom would have had roots in Ireland, North and South — some of the trenches were as close as I am to Dr Adamson, who is across the Chamber.
I do not want to take this point too far, but we now have an Island of Ireland Peace Park at Messines Ridge in Flanders, to which £100,000 was allocated in the December monitoring rounds. If we are truly interested in reconciliation with each other and with our past, it is time to move on and learn from the past. We must respect our shared past as well as our individual pasts. People say that those who died gave their todays for our tomorrows. We should give up our hang-ups of yesterday, so that we can all have a better tomorrow.
Finally, the Irish Government should acknowledge all the Irishmen who died. Instead of the single posy of flowers that President McAleese sent to the memorial at Guillemont on the 1 July 2001, the Irish Government should properly acknowledge the men of Ireland who died in Flanders’ fields believing that they were fighting for home rule.
I support the motion brought before the House by Mr Adamson, Mr Ken Robinson, and Minister Foster.

Mr Jim Shannon: I support the motion, and I compliment the Members who brought it before the Assembly.
The Assembly has been touched by the French Government’s proposal. Members read with disgust and horror the news that they are considering building a runway over war graves at the Somme. It is incredible that anyone could disregard the graves of the brave men who fought valiantly for freedom and democracy more than 80 years ago. However, press reports have indicated that such a plan is being considered.
The manager of the Somme Heritage Centre, Mr Billy Ervine, suggested that the site of the intended runway is not necessarily in the Somme itself, but along the Somme River, outside Paris, where the graves of the British, French and German soldiers who fought the 1914 battles are situated. The site contains approximately 60 graves of British soldiers. It is understood that some of those soldiers hailed from Northern Ireland, and it is almost certain that some were from the Ulster regiments. The proposed runway would affect thousands of dead soldiers’ graves.
The local press has indicated that a similar motion is to be tabled at Westminster. Some Assembly Members have dual hats — those of MLA and MP — and they tend to wear them.

Mr Gregory Campbell: My Colleagues and I have tabled a similar motion at Westminster. There has been a remarkable degree of support among MPs across the divide. It is now a case of galvanising the opposition to the proposal.

Mr Jim Shannon: I thank the Member for his intervention. It is encouraging that the motion has support at council level, at Assembly level and at Westminster level.
Several hundred thousand graves across the world hold the remains of courageous local boys who went far away to fight a war for democracy so that we could enjoy our lives in relative peace. Some of those men died lonely and hungry, ill-clothed for the climate and a long way from home. Do we intend to honour their memory by building a runway over their graves? Some of us had relatives who were killed in the first world war. A small number of us had friends who were killed beside them at the Somme and elsewhere during the first world war. Northern Ireland is a small, close-knit country. When one of us is killed, each and every one of us is affected.
That is why we support the poppy appeal every year, which started in earnest in 1921. The poppy has come to represent all that is good and, at the same time, all that is horrifying about war. Today it is the predominant image of the Great War. I know nobody who can watch with a dry eye the release of poppy leaves during the service at the Albert Hall on the night before Remembrance Sunday. Imagine that the only thing of beauty that those brave men — and many young women who served as nurses — could see in that grey and desolate landscape of carnage and inhumanity was that simple red flower. Poppies covered the fields when man’s inhumanity exploded into the world with a ferocity not seen in any period before the first world war.
The French Government now intend to build a runway on the cemetery where the Commonwealth War Graves Commission and the British Legion have endeavoured to create peace, solace and respect. The French authorities obviously do not care about the honour and respect that is due to their own citizens, since some French citizens who fought for freedom and democracy are buried there.
As one who has served in the armed forces, I know at first hand a little of what was expected of those men. However, I can in no way begin to comprehend how awful it was for those young men to see the bodies and to smell the mortality of men all around them. Through the enormous loss of life during the first world war, the armed forces were able to refine their strategies and develop more sensible — if that is the correct terminology — forms of warfare, instead of throwing men in front of guns and shells.
We owe much to those men, whether they were from France, England, Ulster or from the Irish regiments. They gave their all, and we must do something to protect their final resting places. We must petition the Foreign Office Minister at Westminster to intervene on behalf of the dead soldiers to protect their graves from the encroaching runway.
Our only hope lies in the fact that, some five years ago, Eurostar had planned to run trains through the cemeteries. The company was persuaded to bypass the site and, therefore, honour all those who gave their lives. As a result of that, it is imperative that we get involved and voice our disgust and horror at the intention of the French to dig up our slumbering heroes. We must translate that disquiet into action. We urge the Foreign and Commonwealth Affairs Office to intervene.
The Battle of the Somme played a vital role in the history of our small country. Over 20,000 casualties came from what was then the entire island of Ireland. One poignant example is that of three brothers from Comber who joined up at the same time, were killed together at the Somme in one machine gun swathe and are buried together. That illustrates the impact of the war on families and communities — every village, town and city in Northern Ireland felt its effects.
It is believed that the British Government sent the Ulster troops to almost certain slaughter, so the British Government should make amends. That is why it is important that the matter be addressed at Westminster in an attempt to prevent those who are buried in Chaulnes from being disturbed by what is called "progress".
There are many reasons for observing Remembrance Sunday in Northern Ireland. Many of our fellow citizens have been lost to the ruthlessness of terrorism. One such tragedy took place at the cenotaph in Enniskillen. On Remembrance Sunday we remember, as a nation, not only the dead of the first world war, but those whom we knew personally, and who were killed by undemocratic, ruthless and tyrannical terrorists who thought that they could get the state that they wanted by killing.
Eighty years ago, young men went to fight against exactly the same thing. Now, the bodies of some of those who died while trying to fend off the despotic German leadership of the time are to be moved to make way for a runway. If this were proposed in respect of a graveyard in east — or, indeed, west — Belfast, opposition would have to be expressed only once before the plans would be stopped in their tracks. It is imperative that we put a stop to the proposed runway by adding our voices of rejection as an Assembly and as a country.

Mr John Kelly: Go raibh maith agat, a LeasCheann Comhairle. I compliment Ian Adamson on his eloquent address when moving the motion. As always, he was articulate and civilised in his remarks, and I thank him for that.
Nationalists and Republicans have always had problems with commemorating the first world war. Nationalists, and Republicans in particular, have felt that the war was hijacked — if I may use that word — by Unionism. In many ways, Nationalists felt that they were excluded from commemorating those who fought that war believing, as John Redmond did, that it would deliver home rule for Ireland. There is, and has been, an ambivalence or unease in Nationalism in respect of the remembrance of that event. There is also unease with the poppy. I do not want to discuss that, because it would be inappropriate to do so, regardless of how provocatively the issue may have been introduced.
We recall that many fought in the first world war. I do not mean to glorify war. Ian Adamson said that the first world war "stands like a searing scar across the face of history." Indeed, it is a monument to the savagery of war, in which ordinary men, on the instruction of generals who sat in the background, were sent to their deaths like lambs to the slaughter.
One must ask, as did Francis Ledwidge,
"for what and for why?"
From a Nationalist point of view there are many complexities, doubts and misgivings in that issue, not because we do not remember or think respectfully of those who died at that time but because of the political manner in which it has been hijacked by Unionism. General Tom Barry fought in the first world war and returned to fight in the war of independence for Ireland. Several of the Connaught Rangers were executed in India because they mutinied against the executions of 1916. My own grandfather went to war in 1916. The letter received said that Private John Kelly, aged 37, husband of Maria Kelly, of 4 Marlin Street, Belfast, County Antrim had died on 9 September 1916. He had come from a staunchly Nationalist background.

Mr Cedric Wilson: On a point of order, Mr Deputy Speaker. You have always been very quick to point it out to others if they depart from the motion. The Member of Sinn Fein goes on to eulogise those who fell in 1916.

Mr Donovan McClelland: I shall bear that in mind, Mr Wilson.

Mr John Kelly: My grandfather was a Redmondite. He did not need to go to war. He was employed at that time, but he went to war because he followed John Redmond and Joe Devlin in the belief that he fought for the freedom of small nations, for home rule for Ireland. However, one of the ironies — [Interruption].

Mr David Ervine: Does the Member accept that it may also have been in the mind of his grandfather and of Redmond that they were fighting for home rule for the French?

Mr John Kelly: That is a good point, but I talk about Ireland and would prefer not to get into that. Perhaps it is partly our own fault, but from our perspective the situation has been clouded by the way in which the matter has almost become the domain of Unionism, Protestantism or Loyalism. However, I think that Ian Adamson said that there were 75,000 volunteers from Ulster — 46,000 of them from Belfast — and 150,000 from the other part of Ireland. The difficulty is not in respecting or remembering. It is that we as a community have been made to feel excluded.
As Ian Adamson said, this is a monument to savagery. Many of those people went to that war because they had no other means of livelihood. Some went believing that they fought for the freedom of small nations. Others from the Protestant community believed that they fought for God, Ulster and the Crown.
It is a holy ground, as all graveyards should be. As such, they should not be desecrated. Significantly, they should not be desecrated by Governments. For that reason we support the motion, and we thank Ian Adamson for taking an eloquent and civilised approach.

Mrs Eileen Bell: Today’s debate is an appeal. I hope that if the motion is unanimously passed, it will reduce the feelings of exclusion that some of us have about the first and second world wars and bring us together in a spirit of understanding.
We ask the French Government that, when considering their development plans for facilities such as the new airport in Paris, as formally agreed, the war graves be allowed to remain in their present locations, with due care and attention being given to them in the memory of those who are buried there. As other Members have said, we ask them to remember that the people who are buried there include German soldiers, men and women from all over Ireland and people from England, Scotland, Wales and Canada.
All too often in this modern and inconsiderate world it is easy to forget our past, to forget the tens of thousands of people — some of whom were only children — who made the supreme sacrifice in both wars. I hope that some day all of us, whether Catholic, Protestant, Nationalist or Loyalist, will acknowledge the contribution that those who died made to our future. I endorse Mr O’Connor’s comments about the Republic of Ireland. As he said, those people gave their tomorrows for our todays.
For years the Commonwealth War Graves Commission, with the help of French councillors and others, has kept the war graves in pristine condition. They have ensured that the fields around the graveyards, which were once battle areas, are preserved in an acknowledgement of those who fell in battle, never to receive the last rites or a decent burial.
As another Member said, we cannot allow such a precedent to be set for the destruction of, disruption to, and disrespect for that pertaining to the fallen of the two world wars. We must continue to oppose any such destruction in the graveyards in Rosiers and the other villages that were mentioned, which are now threatened — and there is another development plan for an area near Ypres in Belgium that we must worry about.
The graveyards, battlefields and pathways should be left for the many who come throughout the year to pay their respects to friends and family. I have visited such places several times. Even though I have only two relatives buried there, I remember the strength of feelings that the visits gave me and the impressions that they made on me. I would hate to see them desecrated in any way.
People with little knowledge of the subject do not need to travel to France for an initial impression. They can go to the Somme Heritage Centre and get the information that is crucial to gaining an understanding of the problem.
The Assembly must send a clear message to the French Government that they must alter their plans so that all who are interred in the graveyards may continue to rest in peace. It is essential that they pull back and pay their tribute to the fallen who gave their lives so that all of us, including the French, could have a future.
Death is the main certainty in life. It is important that Members recognise that today’s motion is on behalf of all who died, regardless of creed, background or tradition. It also reflects the attitude of those who went to their deaths.
I end with a quote from the poem ‘In Flanders Field’, which I hope will be remembered by the French Government and all involved in the final decisions.
"If ye break faith with us who die We shall not sleep, though poppies grow In Flanders fields."
I support the motion.

Mr Norman Boyd: I support the motion, and all true democrats should endorse it. The proposed plans to build an airport on the site of the Battle of the Somme are distressing, particularly for the families of those buried there — and that includes many from Northern Ireland — who are faced with the prospect of the graves of their loved ones being moved or disturbed.
The proposed site for the new airport would involve clearing a large area and disturbing the graves of many British and Commonwealth soldiers. I welcome the assurances from the junior Defence Minister, Dr Lewis Moonie, that if the proposals seem to affect cemeteries containing British and Commonwealth graves, the Commonwealth War Graves Commission will firmly resist plans to disturb the war dead.
More than one million soldiers were killed in the battle of the Somme, which took place between 1 July 1916 and 19 November 1916. The small number of survivors of the battle firmly oppose the proposed airport. People who live close to the site also oppose the plans. Residents state that the airport would dishonour the memory of the thousands of soldiers buried in the area. A British cemetery, containing the remains of 20 soldiers killed in March 1918, also falls within the proposed airport boundary, as does a large French military cemetery, which contains six British graves.
The proposed site is the final resting place of about 100,000 British soldiers. Thousands of graves may be dug up to make way for the construction. It is vital that the Foreign Office and the Ministry of Defence intervene in the matter. The Somme battlefield has a special place in the hearts of the people of Northern Ireland. On 1 July 1916, the 36th (Ulster) Division lost 5,500 men at the Somme, and their supreme sacrifice must always be honoured with the dignity that it deserves.
On 1 July 1916 alone, Britain suffered over 57,000 casualties — the biggest ever loss in a single day. Between 1 July 1916 and 19 November 1916, British and Commonwealth casualties totalled 420,000, while the French suffered 200,000 casualties. The Battle of the Somme has been described by many as "hell on earth" — [Interruption]. We must never forget the gallantry and resolute courage of all those who fought in the Battle of the Somme. The words "We will remember them" from ‘The Ode’, the fourth stanza of the poem ‘For the fallen’, which is recited at remembrance services each year, have never been so poignant. I support the motion.

Mr Fraser Agnew: Several years ago, on a visit to the Somme, the late Harold McCusker happened to be in the same group as me. We visited the Wytschaete cemetery, where there is a memorial to the 16th (Irish) Division. Harold McCusker’s great, great grandfather served with the 16th (Irish) Division, and his headstone is in that cemetery. The late Canon Hugh Murphy was also in the group. He was a Roman Catholic priest who had served with distinction in the Royal Navy during the last world war. He took a service —[Interruption].

Mr Donovan McClelland: Order. I am not sure where the disruption is coming from, but it is very discourteous to the House. Mr Agnew, please continue.

Mr Fraser Agnew: The late Canon Hugh Murphy conducted a service at the cemetery. Dr Ian Adamson was also there. Presbyterians, Free Presbyterians, Anglicans and Roman Catholics attended the service. However, my lasting memory is that two councillors from Down District Council laid the wreath — one was a Nationalist and one was a Unionist. The Nationalist was a member of the SDLP and the Unionist was a member of the Ulster Unionist Party. The Nationalist was a member of the Ancient Order of Hibernians; the Unionist was an Orangeman. The Nationalist put on his Ancient Order of Hibernians collarette; the Orangeman put on his Orange collarette, and together they walked to the memorial to the men of the 16th (Irish) Division to lay the wreath. That is a lasting memory that I will have of all of the journeys that I have made to the Somme battlefields.
I welcome the conciliatory note in the House, and we should never forget that people of all races, all religions, both sexes and every walk of life lost their lives during the Great War. We talk about the 5,500 men who lost their lives, or who were wounded during the first two days of fighting at the Somme, and we should never forget the supreme sacrifice — the Somme took the lives of about one million people. However, many more millions — perhaps as many as 10 million — lost their lives in the Great War. Although I would never consider myself a pacifist, a visit to the Somme battlefield would be the one thing that might tip me over the edge towards pacifism. The deaths on those battlefields were such a terrible waste of human life, such a dreadful sacrifice. We hear much about lions being led by donkeys — that may be true. However, we must remember the supreme bravery and sacrifice of the people from Ireland, North and South.
I fully acknowledge the difficulty that Nationalists have with 1916 for all sorts of political reasons that intermingle in the Ulster story. We cannot ignore the fact that people from all communities and walks of life, North and South, lost their lives during the Great War. We should never forget their supreme sacrifice.
In the aftermath of the war, we were told that the French had given land over in perpetuity to be used as cemeteries in Picardy, Flanders Field and Belgium. That land was to be a resting place for those who had lost their lives during the Great War, so that subsequent generations could visit and pay homage to them. I have a problem with the issue of "in perpetuity"; it must be resolved, and perhaps this is the ideal opportunity to do so. If that land was granted in perpetuity, why are we faced with the problem of the closure of the Chaulnes area in Picardy, where many soldiers lost their lives in particularly horrific circumstances?
Those lives were not necessarily lost to enemy weaponry and warfare; many died in a very simple way. The soldiers wore heavy packs on their backs and the ground in that area had been churned up through the ravages of war. As a result, those soldiers, weakened by war, underfed and undernourished, sank to their knees in the mud and fell to the ground face down. Many of them drowned in a sea of mud in an area close to where it is proposed that the third airport for Paris be built.
I support the motion and congratulate my three Colleagues for tabling it. We must never forget the supreme sacrifice made, not only by Ulstermen and Irishmen, but by soldiers and people from throughout the free world. That supreme sacrifice has guaranteed freedom and democracy. We must always remember that.

Mr Sam Foster: I support the motion. The issue is emotive, and it is important to Northern Ireland, Ulster, the whole island of Ireland and far beyond. I have been to the Somme battlefields on several occasions to pay tribute to those who fought and died. The remains of an uncle on my mother’s side still lie in France, and I have two other uncles who returned home from that terrible scene.
I say to Mr John Kelly that this issue is not about "isms"; it is about citizenship, then and now.
Shortly before Christmas it was brought to my attention that the French Government planned to build a third airport for Paris, which was to be situated in the Somme area. As a result, I wrote to the French Embassy in London and to the Commonwealth War Graves Commission to establish the facts and register my opposition to such a plan, if indeed it were the case. It goes without saying that I oppose any move to disturb the final resting place of the many thousands of Ulstermen, from both traditions, who made the ultimate sacrifice in the first world war, and who lie there side by side. They died in defence of freedom and by their actions helped ensure French liberty. It would be an outrage if the French Government were to permit any interference whatsoever with these graves at this particular time.
As regards local interest, there is greater regard in the Republic of Ireland now than ever before about the first world war. There are numerous associations there, and I am friendly with several people from the Royal Dublin Fusiliers Association who are thirsting for information about the first world war and are working hard to learn about what took place — who fought, who died and who gave their lives.
I have received replies from the French Ambassador and the Commonwealth War Graves Commission. The Ambassador has assured me that the French authorities
"have the greatest respect for the graves of those who fell on French soil",
and he sought to clarify several points. He said that even though a decision has been taken to build a new airport in the region, the exact location has not yet been decided and consultations are under way into a number of factors. He promised that
"proper consideration will be given to the existence of military cemeteries",
and pledged that
"all possible measures will be taken to protect the cemeteries."
Further to that, he said
"if it should prove necessary to remove some of the graves, extreme care would be taken to treat all human remains with due respect and dignity and rebury them, if so required, at an appropriate and accessible location…the cost would be borne by the French Government."
Ambassador Bernard said that the French Prime Minister had given a firm commitment that before the final decision is taken there will be consultations with all interested Governments, especially Her Majesty’s Government. He concluded by saying that the French authorities and public
"respect and honour those who gave their lives for our common freedom".
The Commonwealth War Graves Commission said that it was aware of the concern caused by recent media reports, but took the view that
"until the proposals and their implications are clear, the suggestion that Commonwealth War Graves will be disturbed is mainly speculation".
Significantly, the commission did point out that the area around Chaulnes, chosen for the airport, was mainly a French area of operations and considered that few Commonwealth war graves would be affected. However, while my primary concern is about the graves of those Ulstermen who fell, I would still be concerned if the last resting place of the men of any nationality were placed at any risk. That is vital.
The commission said that it was seeking further clarification and would make strong representations should there be any proposal to disturb the graves. It also pointed out that the French Government have, in the past, avoided the need to disturb war cemeteries when similar developments have taken place, notably the TGV fast rail link. It said that it has no reason to believe that the French will act differently in this instance. I therefore propose that the House should monitor the situation, offer support to the Commonwealth War Graves Commission and continue to press the French authorities to live up to their promise that
"the French Authorities and public respect and honour those who gave their lives for our common freedom".
In conclusion, and in memory of those who served and died, I will paraphrase General Douglas MacArthur when he referred to soldiers in another campaign. We did not know of the dignity of their birth, but we must respect the sacrifice and glory of their death and their last resting place. I support the motion.

Mr Donovan McClelland: One more Member will speak, and then Dr Adamson will wind up the debate. Rather than stop the debate and return to it after lunch, I am extending the time to allow Dr Adamson to speak.

Mrs Annie Courtney: I support the motion, and I congratulate Dr Adamson, Mr Foster and Mr Ken Robinson, for bringing it to the House today. We have had a detailed explanation of the history from our two historians, Dr Adamson and Mr Agnew, so there is very little for the rest of us to say regarding the historical context in which the Somme is regarded.
The proposed site is in the middle of a first world war Somme battlefield, and the new airport will involve clearing a large area and possibly disturbing the graves of many Irish, British and Commonwealth soldiers. If the plan is realised and the war dead are disturbed, it will be widely opposed, for it has already been said that more than half a million soldiers were killed at the Battle of the Somme between July and November 1916. The remains of at least 25 British soldiers and 41 Commonwealth soldiers will have to be exhumed and reburied if the airport gets the go-ahead.
The residents of Chaulnes oppose the scheme and say that the airport will dishonour the memory of the thousands of first world war soldiers who are buried in the area. The people of Ireland, North and South, irrespective of their religious or political backgrounds, regard burial grounds as sacred and, therefore, agree that the plan should be opposed. The Battle of the Somme in particular has great significance for the people of the North, both Unionists and Nationalists, and there has been real acknowledgement of the part played by the Irish regiments in both wars.
For that reason I know about the monument at Thiepval, which was first brought to my attention years ago by Ian Adamson. For the same reason, after many years of planning, two politicians from very different backgrounds, Glen Barr from my city of Derry and Paddy Harte from Donegal, a member of Dáil Éireann, collaborated in taking a team of young people to ensure that there would be a permanent monument to the war dead at Messines in Flanders, which was officially opened by Queen Elizabeth, the queen of England, by President Mary McAleese and by the Belgian king. That was a real watershed, which showed how the world wars, and those who gave their lives in them, are regarded by people, North and South.
The monument was opened by these three very prominent people, together with the relatives of the young men who had their short lives ended far away from home. For that reason we must oppose the plan to put an airport through the Somme battlefield. We must respect the memory of the dead and acknowledge the hurt that will be caused if the development proceeds.
Like Dr Adamson I have also been lobbied by relatives, and at the end of last year I met with the deputy burgomaster of Messines and related the concerns of many people to him. He assured me that he shared our concerns and would bring them to his council and support our opposition to the plan. For that reason I am very happy to support the motion, and I hope that it gets the full support of the House.

Dr Ian Adamson: I thank everyone who has contributed to the debate. My co-proposers, Ken Robinson and Sam Foster, made several interesting points about Chaulnes and the Somme. Ken Robinson said that the land was given in perpetuity, which is true. The displacement of war graves must be opposed, or it will become an acceptable fact of life. Ken Robinson did, however, say that the French Government gave due sensitivity to the building of the TGV fast rail link, and perhaps that sensitivity will be seen in Chaulnes as well. But what if Verdun had been proposed as a site for an airport? Surely that could never have been considered in France. Ken Robinson thought that the Chartres region might be a much more appropriate alternative.
Danny O’Connor, who accompanied us to the Somme last year, spoke of his relatives and of the 16th (Irish) Division’s memorial at Guillemont. Of course, the whole area is a cemetery, which stretches as far north as Belgium, where the Island of Ireland Peace Park now exists in Messines. Annie Courtney spoke of that area, which was developed by Glen Barr and Paddy Harte through the auspices of the two Governments. Although the Irish Government could perhaps do more to acknowledge the first world war, they have already done a lot for the development of the Island of Ireland Peace Park.
Frazer Agnew spoke of Wytschaete near Messines, where our old friends Harold McCusker and Canon Murphy came together at the wonderful ceremony that we had there. Jim Shannon was quite distressed about the problem that surrounds the area. His Colleague, Gregory Campbell showed us that our colleagues at Westminster are completely involved in the issue. Westminster, this Assembly, the local councils and our European colleagues all have a part to play in preventing any desecration of sites in France.
Mr Campbell spoke of the great role of the Royal British Legion. The Royal British Legion has accompanied our Somme Association to France on every occasion, and has done much to help the veterans of the first and second world wars and other conflicts. We join Jim Shannon in urging the Foreign Office to take a strong attitude toward the French Government in this respect.
John Kelly spoke of the problems that Nationalists have because of their feeling of exclusion. I hope that that feeling will eventually die out. On our first visit to the Somme we visited the grave of Willie Redmond — brother of John Redmond — who was really too old to fight in the first world war. When Willie Redmond was wounded with the 16th (Irish) Division, he was brought to a local first aid camp by members of the old Ulster Volunteer Force (UVF).
The rights of small nations were very much a focal point for those Nationalists who went to France, because of the invasion of Belgium. I take great heart that Tom Hartley, a Sinn Féin councillor on Belfast City Council, now takes people round the first world war sites in the Belfast City Cemetery and Milltown Cemetery.
Mrs Eileen Bell has been one of the most loyal supporters of the Somme Association and has been to the sites in France several times. She spoke of her hope that the Irish Republic would take more notice of the first world war. She also spoke of another issue that will loom large in the following weeks and months — the development plans at Ypres, where the proposed motorway goes right through Passchendaele, where so many people fell. She gave a plug to the Somme Heritage Centre between Bangor and Newtownards, where you can see whole episodes of the first world war from both Unionist and Nationalist perspectives.
Norman Boyd said that the proposed plans were distressing. He hoped that the Commonwealth War Graves Commission would firmly oppose the plans. I feel that it will. We have been in frequent contact, and it promises to press the point completely. We must never forget the sacrifice that those men and women made in the first world war.
My friend, Sam Foster, has accompanied us regularly to France over the years — first as a councillor and then as an MLA. He spoke about the increasing knowledge in the South of Ireland about the first world war, and in particular the work of his friends, the Royal Dublin Fusiliers Association. I went to the Dublin Civic Museum to see its presentation a year ago. It was remarkable; the place was packed. I have also visited Drogheda to see the cross-border co-operation apropos the first world war that exists in that city.
There is consensus in the House, among both Nationalists and Unionists, for this proposal, which I am glad of. In Helen’s Tower at Clandeboye there is a poem by Alfred Lord Tennyson, which is perhaps the best poem written about Helen’s Tower. It reads:
"Helen’s Tower here I stand Dominant over sea and land Son’s love built me, and I hold Mother’s love in lettered gold. Would my granite girth were strong to either love, to last as long. I would wear my crown entire to and thro’ the Doomsday fire, and be found of angel eyes In earth’s recurring Paradise."
The memorial room of the Ulster Tower at Thiepval has, carved in gold around each of the walls, the first four lines, only slightly altered to make them a fitting tribute to those other sons — the sons of Ulster and the sons of Ireland — who together passed through "Doomsday fire" for their king and country or for the rights of small nations
"Helen’s Tower here I stand Dominant over sea and land Son’s love built me and I hold Ulster’s love in lettered gold."
Their name liveth for ever. Thank you for supporting this motion.
Question put and agreed to.
Resolved:
That this Assembly notes the intention of the French Government to build a new airport in the area around Chaulnes in Picardy to serve Paris and requests the UK Government to consult closely with the French Government to ensure that due respect and honour are paid to the graves of those who gave their lives in the two world wars.
The sitting was suspended at 1.06 pm.
On resuming (Mr Deputy Speaker [Sir John Gorman] in the Chair) —

Health Crisis in Hospitals

2.00 pm

Mrs Iris Robinson: I beg to move
That this Assembly calls on the Minister of Health, Social Services and Public Safety to take immediate action to address the health crisis in our hospitals.
I wish to make it abundantly clear from the outset that the motion is in no way intended as an attack on, or criticism of, the dedicated people who work hard and with professionalism at all levels of the National Health Service. Indeed, it is because of the pressures faced by the doctors, nurses and support staff in the National Health Service and, in turn, the negative impact on patients in Northern Ireland that the DUP sought the opportunity to debate the matter.
I pay tribute to all Health Service employees for the continued loyalty to their vocations despite the serious conditions in which they work. It is certainly not the pay and conditions, or the stress-free environment that encourages them to keep working in the Health Service. Without their dedication, the current crisis would be one hundred times worse.
The Dickensian state of our Health Service shows no sign of improvement. Each time the issue is debated in the Assembly or elsewhere, circumstances have inevitably become more serious, and the crisis deepens. Some have described the current crisis as a "meltdown" of the National Health Service. We are certainly heading that way. Every possible index of the state of the Health Service illustrates clearly that deterioration, through the long waiting lists, the long hours worked by junior doctors, the number of trolley waits and the lack of community care packages.
I note, sadly, that the Minister of Health, Social Services and Public Safety decided not to take up the genuine offer from Dr Peter Maguire, the chairman of the Northern Ireland Junior Doctors Committee of the British Medical Association, to shadow him at Craigavon Area Hospital. Had she done so, she would surely have had confirmed to her at first hand just how bad things are becoming.
It does not get much worse for the National Health Service when we consider the disgraceful acts of violence that took place at Altnagelvin Hospital at the weekend. That mindless and thuggish violence shows that National Health Service employees are under pressure from all conceivable quarters. I am sure that the House will want to record its disgust at that violence and the extra pressure that it creates for staff and patients at Altnagelvin, as it has done in other hospitals in the past.
It gives me no pleasure to state that every aspect of the Health Service, including staff morale, service provision and public confidence, reflects the same depressing reality that a crisis is upon us. Each time the National Health Service in Northern Ireland is examined and debated, we get the same vacuous response from the Minister of Health, Social Services and Public Safety. It amazes me to this day that she repeats the same old rehearsed excuse. How many times have we heard the line that it is the fault of the Tories?
It is almost as if the last five years of new Labour had not happened. We cannot continue to blame the Conservative party for all our woes. We must look closer to home for some of the blame. We have to face up to the fact that a local Minister has been in charge of health for approximately three years, but rather than there being even a slight improvement, things are getting worse than they ever were under direct rule.
Under direct rule we made the justifiable complaint that unaccountable Ministers were making decisions without consultation. However, we now have a local Minister who has consultations but who never makes any decisions. That must be addressed if we are going to stymie and turn around the decline in the Health Service. At present the Health Service is rudderless — it has neither direction nor any real strategic plan. The Department of Health has spent the vast bulk of its time reviewing the problems with the Health Service while delivering little guidance on how to move forward effectively. The Department, it appears, is permanently in review.
I noted with interest the Minister’s article in last Thursday evening’s edition of the ‘Belfast Telegraph’. She mentioned at least four reviews and strategies that have been commissioned by the Department of Health — the acute hospital review, the cardiac surgery review, the comprehensive review of health and social services workforce planning and the preparation of a regional strategy. While those areas need serious attention, one cannot help but feel that the Department and, in particular, the Minister are hiding behind continual reviews instead of bringing before the Assembly a firm and attainable blueprint of the way forward for the National Health Service.
Much has been made of the lack of adequate funding for the Health Service in Northern Ireland. I am sure that the word "underfunding" will be mentioned many times today. Such is the importance of funding, or rather the lack of it, that I have personally raised this issue on numerous occasions, both within and outside the Chamber. The disproportionate and unfair nature of the Northern Ireland health budget, compared to that of our counterparts in the rest of the UK, is such that only the term "second class" befits the way in which the British Government treat us.
Northern Ireland has higher levels of need and demand than our English counterparts. We need to bear in mind the expenditure that is lost to the Health Service as a result of paramilitary punishment beatings and shootings. Those broken bodies require emergency treatment, months of nursing care and, in many instances, rehabilitation. Just think what we could have done with the millions of pounds that have had to be set aside because of that unacceptable behaviour.
We expected that funding would be, at least, matched with the rest of the United Kingdom. However, not only do we get less, but future increases show that we receive demonstrably lower funding allocations than England. If we were to receive the same rate of increase as England over the next few years, we would see the striking disparity between Northern Ireland and England. Had we matched their rate, we would have gained £83 million last year, £138 million on top of the draft Budget proposals for 2002-03 and £214 million more than the indicative allocation for 2003-04.
Northern Ireland is desperately underfunded by comparison with England and Wales. If our Health Service is to turn the corner, we must have fair, proportionate and immediate financing of the service in Northern Ireland. Moreover, it is vital that the money that is currently apportioned to health here be wisely used. The Health Minister has a budget of over £2 billion. That is a good deal of money, but various interested parties have rightly queried whether that money is being used to best effect. The Assembly must address that.
Areas of the Health Service are being dangerously ignored. There is no mention in the 2002-03 Budget of the proposed new cancer hospital at the Belfast City Hospital site. We ignore the issue of cancer at our peril; we need to bear in mind that cancer will overtake heart disease as the number one killer in the UK in the next few years. Therefore, I call on the Minister to pull out every stop to ensure that funding is secured for this centre of excellence for the treatment of all variants of this dreadful disease. Last year, 31% of eligible women had not had a cervical screening test in the previous five years, and 28% of women aged between 50 and 64 had not had a breast screening test in the previous three years.
If we had had that additional money, proper health promotion campaigns could have educated our people, and many more lives could have been saved. Currently, cancer patients often have to wait too long to see a specialist: this delays diagnosis and treatment, causing anxiety and distress. Often people have no choice but to travel to Belfast for treatment instead of being treated locally, and this adds to their stress.
The absence of haematologists in the Western Board area forces patients to travel to Belfast. Last year’s resignation of a radiologist at Antrim Hospital caused delays in diagnosis. Attracting and keeping qualified staff remains difficult. Better financial support across the service would benefit many needy people.
Surely it is time for a radical overhaul of the direction that is being taken by the Department and its Minister. Members would agree that after three years in the post, the Minister must do more than say "I know what must be done" — of course, I refer to the title of her article in the ‘Belfast Telegraph’. It is not good enough that she should merely admit that she knows what has to be done. People in Northern Ireland demand to know what will be done, and when.
Members are fully aware of the seriousness of the crisis. One does not have to be a member of the Committee for Health, Social Services and Public Safety to encounter health issues. Members in my party receive, day and daily, complaints and queries by letter, phone or in person about the state of the Health Service. In my constituency of Strangford, I have seen, more often than I care to remember, the frequent problems and deadly effects of the growing burden on the service.
Some Members may have read in the ‘News Letter’ recently the terribly sad and disturbing story of a disabled constituent of mine who suffered from numerous illnesses. His wife and son are also registered as disabled. In October my constituent became sick — to such a degree that his family called for an ambulance, which took him to a local hospital. He was told that it was just his arthritis acting up and was sent home without further treatment. Over the next four weeks his condition worsened and on numerous occasions he begged to be taken into hospital for proper treatment. During the following weeks he was taken to hospital a further seven times by ambulance, and each time he was sent home. Such was his pain that the poor gentleman had to sleep sitting up at night because he felt suffocated when he lay down.
A local community worker came to hear about his situation and advised him to go immediately to the hospital and demand a more thorough examination. He did this on Tuesday 6 November. On the same day, after numerous tests, he was told that he had no more than 24 hours to live. Tragically, the gentleman died the following day. His family are now left without a husband or father, all because of the pressure on staff and the lack of time to deal with him adequately. That tragedy symbolises all that is going wrong with our Health Service today.
Many Members could probably relate as sad a story. I spoke recently to a radiologist from Belvoir Park Hospital who informed me that the machinery had broken down, yet again. That resulted in the cancellation of appointments and a backlog of patients who did not receive their treatment. In some instances seriously ill patients have been sent home from hospital due to the pressures on the system.
The words of Dr Peter Maguire reflect a sad reality
"We are on the road to nowhere. The Health Service is in tatters, and we must get our act together."
These words are an accurate description of the state of our Health Service. In getting our act together, the Minister must tackle the issues that strongly affect public confidence. One such example is the offer of an MRI scanner to Belvoir Park Hospital by the Friends of Montgomery House. That offer must be accepted, as to do otherwise would be criminal. I ask the Minister to undertake to find the necessary running costs to ensure the maximum use of this scanner by the patients at Belvoir Park Hospital. She must recognise that her framework on waiting lists has failed to deliver.
The Minister’s review of acute services has run into the sidings and is far too costly. Her plan to abolish GP fundholding seems to have more to do with politics than patients. One has to ask who will be the losers from the lack of an appropriate scheme that would take account of the advantages gained through GP fundholding.
The Minister was advised in the House that if circumstances such as an epidemic of the flu virus arose, the Health Service would face chaos. That did happen, and over 100 beds in four hospitals had to close because of a viral gastro-enteritis bug. As a result, the waiting time in Craigavon Area Hospital was 36 hours, and non-emergency surgery had to be cancelled. Such problems are arising across the Province, and those waiting to be admitted to hospitals are being told that emergency-only treatment is available. I wait with interest to see how many patients were waiting to be admitted to hospital at the end of December 2001 — those figures are not yet available.
In the light of the situation, the Minister needs to act in the following ways. First, it is time that the Minister listened to and respected the views of the Assembly’s Committee for Health, Social Services and Public Safety. She has failed to do that so far. It is time that she laid aside her own politicking and concentrated on health matters. Next, she needs to lay before the Assembly a commonsensical and realistic blueprint that will reflect the concerns of Members and the public. A firm grip needs to be taken on the £2 billion that is being spent by her Department. Instead of attacking the trusts, the Minister needs to get her Department into shape, and if that means downsizing and streamlining it, so be it.
The Minister needs to take a serious look at the number of boards and trusts and take the necessary steps to reduce their number. She needs to bring her recommendations to the Assembly’s Committee for Health, Social Services and Public Safety with a view to getting an agreeable working plan that will allow real money to be released to the Health Service. It is time that the number of administrative bodies and quangos were cut, so that money could be released to front- line medical services. It is only when the Minister and her Department resolve to tackle the issues in a determined manner that we will be able to build a better service. The current crisis will deepen if these issues are not tackled. Elected representatives cannot stand idly by and allow that to happen. We owe it to Health Service staff and to the patients across the Province to build a strong and durable health system. I call upon the Minister and her Department to provide vision and leadership to achieve that goal. If that necessary leadership is lacking, they will be judged accordingly.
There is much to be proud of in our National Health Service — many good and dedicated people make the best of a bad situation to provide a caring service. Members will agree that a root-and-branch change to the current set-up is vital for everyone’s sake in Northern Ireland.
I call upon the Minister of Health, Social Services and Public Safety and her Colleague the Minister of Finance and Personnel to seek an immediate meeting with the Chancellor of the Exchequer, Mr Gordon Brown, and press him for equality of funding for Northern Ireland. It is no longer acceptable that this country should continue to be treated less favourably than other areas of the UK. Just imagine the service that we could have if there were agreement on its future direction, and the means of achieving that goal, and if proper and adequate funding were found to finance it.
I urge Members not to allow the debate to become yet another in a long line of health debates. If we do not act now, who knows what the service will be like when the next debate is heard. I strongly urge Members to support the motion.

Dr Joe Hendron: I welcome this important debate, which has been initiated by Mrs Iris Robinson. Prior to making my main comments I will mention the money for the MRI scanner for Montgomery House. I have written to Mrs Christine Lynch about that scanner and about the fantastic work that is being carried out, and I hope that the Minister can find the funding for it. I appreciate the fact that the Minister is present for the debate.
The chaos in the Health Service cannot go on indefinitely. Patients waiting on trolleys and the war-like zones in our major accident and emergency departments have to be sorted out. Patients are not cattle, to be cast aside until beds become available. The magnificent hospital staff, the doctors, nurses and allied workers, can no longer be taken for granted. "Meltdown" would be the appropriate word to describe the state of the Health Service if it were not for the dedication and resilience of the front-line workers, who are tired, frustrated, overworked, underpaid and whose perception is that they are undervalued.
My colleagues on the Committee for Health, Social Services and Public Safety and I have visited several accident and emergency departments to see conditions at the coalface of health delivery. The Minister, Ms de Brún, has inherited a situation in which the health status of the population is one of the worst in Western Europe. Although over 41% of the Budget goes to the Health Service, there is still considerable underfunding here by comparison with England, Scotland, Wales and other countries in Western Europe.
There is a crisis in orthopaedic and cardiac surgery. The level of staffing and facilities available for trauma and orthopaedic services here is the lowest of any NHS region in the UK. Waiting times for the treatment of fractures are appallingly long. Some people have had to wait for a week for treatment of fractures of the neck or the femur. When I was a medical student I was taught that such fractures required emergency treatment within 24 hours.
Waiting lists are growing. The latest figure was that 56,700 people are awaiting treatment. Recently, I was in Craigavon Hospital, as were several colleagues, and I watched young professionals and others work on the front line. Although there is a major problem with funding, I got the feeling that there ought to be more co-ordination of services between boards and trusts. Therefore, last Wednesday I proposed to the Committee the immediate establishment of an emergency task force, representative of doctors and nurses who work in the accident and emergency departments of our main hospitals, and senior administrators. I am pleased to say that the proposal was carried unanimously.
Members will note that I have called this a "task force" — not a review that will go on indefinitely. The task force will encourage a collaborative approach to accident and emergency services at operational level. It will join together the experience of key clinicians and senior nurses working in the acute hospital front-line service. It will produce its initial report within weeks.
There is a clear need for close work at operational level and for integrated planning at strategic level. There must be a more meaningful co-ordination of emergency services across the four boards and the relevant trusts. I could cite many examples, but I want to concentrate on two of them. First, the Causeway Hospital sometimes buys services from the Eastern Health and Social Services Board, when, perhaps, it could buy from the Western Board, which is not under the same pressure. Secondly, beds are sometimes available at Daisy Hill Hospital in the Southern Board, while Craigavon Hospital is bulging at the seams. There may be reasons for that that I am not aware of, but those facts were pointed out to me.
The current day take-in system between the City Hospital and the Royal Victoria Hospital should be replaced as soon as possible by a system of continuous take-in for general emergencies. There is great sympathy towards that idea in both hospitals. The Eastern Board, if not the Minister, should implement that. Each hospital should receive admissions from its local population and only those emergencies that require the specialist services provided only by the staff of each hospital.
Capacity issues must be addressed urgently. Priority should be given to hospitals that are consistently unable to provide enough beds for the general emergency treatment of local populations. For example, there have been great pressures on the Ulster Hospital and the Mater Hospital. The ability of hospitals to cope with emergency admissions depends on the ability of their primary care and community services to avoid unnecessary admissions and ensure timely discharge. However, the Minister is about to impose new structures on primary care. On 1 April 2002, the system of GP fundholding will be replaced by local health and social care groups. It is important to note that 90% of healthcare is delivered at the primary care level. Primary healthcare is available 24 hours a day, 365 days a year. A year ago, on behalf of the Committee for Health, Social Services and Public Safety, I successfully introduced an amendment on the continuation of GP fundholding in an effort to ensure a seamless transition to the new structures of primary care. That seamless transfer has not taken place.
The new groups will be committees of the boards. Instead of moving towards a primary care-led Health Service, as was envisaged by the Prime Minister, Tony Blair, we are merely giving more power to the boards. We are going to get a top-down rather than a bottom-up Health Service. A golden opportunity to give the long- suffering people of Northern Ireland the first stage of a top-class Health Service is being missed. The British Medical Association has been making that point about primary care for some time — this is a golden opportunity, if we have not already missed it. This is a once-in-a- lifetime opportunity to get primary care right. Primary care is the base of the triangle. If you cannot get primary care right, you cannot get other services right — in particular, secondary care and hospitals. We want to deliver a robust, patient-focused, responsive and truly integrated service to local communities, in which the patients come first. However, it seems that we are introducing, instead, another layer of bureaucracy under the control of the boards.
I appreciate that this is a complex subject. I am not in the business of "bashing" the Minister or anyone else. However, I am in the business of doing my work as the Chairperson of the Committee for Health, Social Services and Public Safety. As someone with long experience of primary care, I believe that what is proposed for 1 April 2002 will cause massive problems across Northern Ireland. Health professionals say that to me. The Minister recently met regularly with many people, such as Dr Brian Patterson, the chairperson of the General Practitioners’ Committee (NI) of the British Medical Association.
To ensure success, primary care groups should be driven from the bottom-up. Primary and secondary care services are independent, though neither can be looked at in isolation, as Maurice Hayes pointed out. His remit was acute hospitals. However, the Committee persuaded him to examine primary care also, because you cannot consider one without the other. The British Medical Association has sent to all Members a circular in which it makes some points about primary care. It says:
"It is important that proper foundations are laid at the beginning if not to miss a major opportunity to create the most effective primary care system, which would complement and help alleviate the pressures in secondary care services."
Significant extra funding must accompany a new integrated, collaborative approach to healthcare provision, if we are to bring about the necessary improvements across the community and hospital settings. Northern Ireland has higher levels of deprivation than Great Britain. However, historically, it has received lower funding for health services. During the 1990s, while expenditure on health and social services in Northern Ireland grew by 35% in real terms, the growth in England amounted to 57%. The figures from the comprehensive spending review for 2001-02/2003-04 highlight a deteriorating situation. Given Northern Ireland’s well-documented poverty and historical lack of investment in health, it is unacceptable that it should not enjoy at least a pro-rata increase in line with that in Great Britain.
We have an opportunity to get primary care right. The people of Northern Ireland deserve the very best, and that is what they should get.

Sir John Gorman: Many Members wish to speak. Each Member will have eight minutes.

Rev Robert Coulter: I too support the motion and am glad of the opportunity to pay tribute, as Mrs Iris Robinson did, to the loyalty, dedication and professionalism of those who work in all levels of the Health Service.
The Chairperson of the Health Committee outlined the complexity of the problem. There can be no quick fix for it. As I said yesterday, it will take the very best co-operation among us all to look at the situation and to work together. We should not try to score any points at any level for ourselves. Rather, we should look at the tremendous problem in the Health Service and work together to rectify it.
The debate gives us the opportunity to express the concerns of those who are worried about the situation, particularly those who are on waiting lists, those who are waiting to see a consultant and those who are beginning to lose hope that, when they are called, it will be in time to do anything about their problems.
One can only begin to imagine the concerns in the mind of someone who has been told that he needs a critical cardiac operation immediately, only to be told by a consultant that the operation cannot be performed for another year or 18 months. His family are concerned about his condition. He rises every morning wondering whether it will be his last day on earth. He is waiting for a message to come, but he knows that it will not come in the immediate future.
Similarly, one can only imagine how someone with a cancerous tumour feels when he is told that he cannot have an operation for many months. As Members of this House, we must take that situation on board. We must critically examine the system wherein people are unable to have the treatment that they long for and require.
The problem is not centred on hospitals alone. When Dr Hayes began to consider his brief, we told him that the problem of acute hospitals could not be viewed in isolation — the entire system must be looked at. I am glad that Dr Hendron pointed out that if we do not get primary care right, then every other part of the system will be wrong.
Without repeating the eloquent comments made by the Members who have spoken, several points must be made. There should be directed finance at the critical points of the Health Service. If finance is not directed, it will become, as I said to the Minister of Finance and Personnel, "confetti currency". It will blow in the wind and disappear. There will be no way to have accountability. It will not be possible to trace finance through the system.
We should look at the contracts of those who work in the system. Doctors are one example. Hospital start courses for junior doctors are not in line with the take-up for postgraduate doctors. I am told that hospitals will employ doctors only on a one-year contract, because the hospitals must pay for doctors for the first three years. Therefore, after completion of a one-year contract here, doctors go to seek work across the water, in England or elsewhere. If we are to keep our doctors, that system must be changed.
The contracts must be examined. Consultants’ contracts should also be examined. Much of the problem is that people are either waiting to see a consultant or are waiting for the treatment that the consultant has prescribed. The existing contracts need to be reviewed and revised.
The training of nurses and the retention of nursing staff should also be considered. Recently it was my privilege to attend the graduation ceremony of the nursing faculty at Queen’s University, Belfast. It was impressive. One reason for that was the number of young people who, despite the difficulties in our Health Service, are coming forward to take up a career in that service. However, the stress they will face, the conditions in hospitals and the lack of morale among people already working in the system will result in many of those young people, after a very short time, going elsewhere to pursue their careers.
Buildings are outdated and equipment needs to be updated. But the most debilitating effect on those who work in our health system is caused by the apparent lack of decision by those who control it. I said in a previous debate that decisions are needed in the short term, not more consultations and more blame. If that "mind change" could be achieved — so that instead of blaming one another, each of us could contribute in our own way and could work together to the betterment of our system — decisions could be made in the short term to benefit those who are currently concerned and worried. To be told "Yes, we are consulting" is not much comfort to someone lying on a trolley in a hospital corridor. That person wants action, not words. I support the motion.

Mr John Kelly: Go raibh maith agat, a LeasCheann Comhairle. It is interesting that Assembly Member Iris Robinson chided the Minister for politicising her role. No issue is more politicised, inside or outside the Assembly, than health, and the only reason for that is the Minister’s political position. That is the only reason, and most of the politicisation has been by the Democratic Unionist Party.
Last Friday, an agricultural item on the BBC programme ‘Newsline’ compared our health with that of animals. I objected strenuously to the programme at the time, but I have yet to receive a satisfactory reply from the BBC. Health has been politicised because of the party to which the Minister belongs.
Every party had the opportunity to take the health portfolio when it was offered on the first day on which the Assembly sat. Each party in turn passed the chalice to Sinn Féin, who accepted it. I contend that Sinn Féin, and the Minister, have behaved in a very responsible, progressive and energetic manner in relation to health. She has attempted, despite the backdrop of a lack of financial resources, to address the problems. Unfortunately, the political sniping continues. A similar motion was debated two weeks ago. If that is not recycling and politicisation, I do not know what is.
Dr Maguire met members of the Committee for Health, Social Services and Public Safety, and last week its members fulfilled their promise to him when they visited Downe Hospital. It was noticeable that no members of the DUP attended the Committee’s meeting with Dr Maguire and the executive of Downe Hospital — so much for their care for Downe Hospital and the extreme circumstances in which it finds itself.
It has been said before that health is an emotive issue — an issue that people play politics with. However, I am not going to play politics with it, nor is my party. We have a genuine concern, given our background as a socialist party, for the welfare of people in our society. We are not here to play the politics of the DUP.
People’s health is the central responsibility of the Government. If we have a Government here, they should deal with the critical issues of our time. It is interesting that Assembly Member Iris Robinson said that it is not just a question of funding, yet she wants the First Minister and the Deputy First Minister to meet with the British Chancellor of the Exchequer to ask for more.
It is also interesting that, although my Colleague Sue Ramsey and I proposed, in November, that the Committee for Health, Social Services and Public Safety should meet with the First Minister and the Deputy First Minister, we did not receive a reply until last week — so much for the concern for the financial problems in the Health Service. So great is the Executive’s concern that they did not respond, as a collective, to our request for a meeting with them until last week. We are sick and tired of the political sniping over the health of our community — political sniping that extends beyond the Assembly into some areas of the news media as well.
We are talking about the health of the people who live in our community. Health has no sectarian walls or divides because it affects all of us. If a person is sick, it does not matter whether he or she is a Prod or a Taig: everyone requires treatment for his or her illnesses. A fracture requires treatment; cancer requires treatment; and a heart condition requires treatment.
We must work together to form, as Joe Hendron mentioned, a cohesive and collaborative approach to the Health Service. It is wrong for people to sit on the sidelines, not participating in the Executive, still wanting the largesse of the Assembly and the largesse from the Good Friday Agreement, but ignoring their responsibilities to the Good Friday Agreement. Those people have little room to talk about the Department of Health, Social Services and Public Safety, or any other Department, given the disgraceful attitude of their party to the Executive and their neglect of the Executive and the Good Friday Agreement.

Mr Peter Weir: Will the Member give way?

Mr John Kelly: When we stand up, you people refuse to give way, so I will not give way.

Sir John Gorman: I ask the Member to address his points through the Chair.

Mr Maurice Morrow: On a point of order, Mr Deputy Speaker. Is the Member addressing the motion? I would like you to rule on that because he does not seem to be doing so. He seems to be on a political rant, and it is neither the time nor the place for that.

Mr John Kelly: They do not like the message, so they want to shoot the messenger. I suppose that it is not the first time that they have shot messengers.
As Dr Hendron said, the Committee for Health, Social Services and Public Safety has attempted to address the issue of health, with whatever ability we have, in a non- partisan way. The Committee has visited most of the hospitals in the Six Counties. We have met staff from all areas of the medical profession — midwives, nurses, consultants, junior doctors, and members of the British Medical Association (BMA). The underlying problem, according to them, is the lack of funding in the Health Service. There is no escaping that fact — however much others may wish to cover it up with calls for inquiries about where money went in the past. The Health Service needs funding, not only for crisis management but also for a health strategy. The Health Service needs a strategy that goes beyond the present crisis into next year, and the year after, and so on.
Members have talked about the Chancellor of the Exchequer: Gordon Brown himself said that the Health Service in England, Scotland and Wales had suffered 50 years of neglect. Charlie McCreevy, the Minister for Finance in the Twenty-six Counties also said that there was a shortage of funding. I call on the Executive to make the health of our people their number one priority — [Interruption]. You sit down. You cannot stand up.

Mr Kieran McCarthy: Mr Deputy Speaker, you have asked Members to limit their speeches to eight minutes. I could spend 108 minutes on the subject. It has all been said before, so I will be as brief and to the point as possible.
The Health Service is in crisis. It has been in crisis for a long time — since before Bairbre de Brún came on the scene. Many people are suffering unnecessarily, which is disgraceful and totally unacceptable. The crisis in the Health Service exists across the whole range of health provision. There is a lack of hospital beds; a lack of services for patients who suffer from a vast range of complaints; a lack of outpatient facilities; problems with regular and emergency treatment; and a shortfall in the provision of good quality care in the community. Vital drugs, which could improve the quality of life, are withheld, and the latest digital hearing aids, which could make such a difference to people with hearing disabilities, are still not provided free, despite the fact that Minister de Brún has asked for funding for that provision.
The crisis in the Health Service was fully debated just before Christmas. The Assembly and the Executive have now agreed that health is the number one priority, which, in itself, is progress.

Ms Sue Ramsey: I accept that the Executive and the Assembly have agreed that health is the number one priority. However, that was not reflected in the December monitoring round, when only £7·8 million was allocated to health.

Mr Kieran McCarthy: I accept what Ms Ramsey says, and I hope that the Minister of Finance and Personnel will take that on board.
Before Christmas, we fully discussed the lack of provision in the Health Service. The pressure to greatly improve services must continue. Members must continue to put pressure on. I appeal to all Members to forget about who is to blame. Now is the time for us all to band together, as Rev Robert Coulter has already said. We must work together to get the best possible services from the resources that we have, to give everyone decent quality healthcare — maternity care, primary care, hospital care and community care. Free nursing and personal care must also be provided. In that way, everyone can be assured of a quality health service from the cradle to the grave.
I welcome the extra money that was allocated to health this morning. It is not nearly enough, but let us hope that it will be used wisely for the benefit of everyone.

Mr Denis Watson: I support the motion, and I pay tribute to staff in the Health Service for their continued professionalism and devotion to duty. Once again we are discussing the serious situation in our Health Service — a service which has been thrown into further crisis.
I do not share the views of some Members who think that the issue should be put on the back-burner. This is an important issue that must be kept to the fore at all times until it is finally resolved. The crisis will not go away until we make serious decisions and take effective action to ensure the long-term future of the service and develop mechanisms to cope with the situation.
In the last debate, I raised specific issues about Craigavon Area Hospital Group Trust that have since come home to roost. The cries for help were genuine. They came from staff who have been working under emotional blackmail in the Health Service for many years. The crisis at the Craigavon hospital peaked on Monday 7 January, when 31 patients were waiting for beds. The situation was highlighted extensively in the media, and while it concentrated on the accident and emergency services, all of the hospital services were under pressure.
The trolley waits have been reduced — yesterday they were down to 17, which is still unacceptable. It is a stark reminder of the lack of capacity in the hospital, which presents an unsafe environment for patients and staff. That must be addressed. All medical, nursing, administrative, portering and domestic staff have worked, and continue to work, extremely hard in difficult circumstances to ensure that a high quality of care is maintained for all patients.
There are currently 433 beds in Craigavon Area Hospital Group Trust. In 1993, there were around 600 beds across the trust, and about 200 in South Tyrone hospital. In the same year, the numbers of patients treated were as follows: 21,000 inpatients; 76,000 outpatients; 36,500 accident and emergency attendances; and 2,138 deliveries. In 2000-01, there was a 23% increase in the number of patients treated. The total numbers treated were as follows: 25,886 inpatients; 130,161 outpatients, representing a 71% increase; 70,815 accident and emergency attendances, representing a 94% increase; and 2,567 deliveries, representing a 20% increase.
The increase in workload and the corresponding reduction in beds reflects the ability of staff to provide a high level of care in a rapidly changing environment. The Craigavon Area Hospital Group Trust is discussing a 10-year strategic plan with the Southern Health and Social Services Board and the Department. I urge the Minister to make a long-term commitment to, and investment in, Craigavon hospital, which plays a vital role in the delivery of acute hospital care in the south of the Province.
Bed-capacity problems are evident across the Province, as the main hospitals do not have the beds, the staff or the resources to deal with the number of patients currently requiring treatment, which results in long and growing waiting lists. The main hospitals in Northern Ireland have the biggest demand for services. Sadly, only about 10% of the work in Craigavon hospital is elective or planned surgery. That figure is being reviewed weekly, with the trust carrying out as much urgent elective work as possible. However, some of the smaller hospitals have less demand for services and much shorter waiting lists. The pressure remains on the acute hospitals, and the problem has been well documented. The Minister must acknowledge that, with the limited capacity in hospitals, the necessary emergency work must go ahead as a priority, and other ways must be found to manage the planned work, and reduce the unacceptably long waiting lists. Many of my constituents would be more than happy to travel some distance to receive elective surgery at other hospitals that have the necessary capacity, rather than remain on the waiting list for Craigavon hospital.
A review of how elective work is managed across Northern Ireland is urgently needed so that the workload can be spread more evenly across all hospitals in the Province. Surely it is time for a closer working relationship to be forged between the management teams of various hospitals to ease the inequalities in access to the Health Service.
We all know that the Health Service has been blighted by bad publicity. There are difficulties in recruiting medical and nursing staff, and many experienced staff are leaving because of low morale and lack of job satisfaction. That impacts on those who remain, and makes it difficult to sustain even the present levels of care. That needs to be addressed urgently if safe care and quality of care are to be maintained and improved.
It was welcome to hear the Finance Minister announcing an additional £7·8 million today on top of the £8 million that has already been allocated. However, there is no use throwing money at the Health Service during the year, because that is not a solution to the problem. We need significant long-term investment, and it must be equitably distributed across the Province. The Health Service must be properly resourced; managers need to know the level of available resources so that services can be properly planned, run and maintained. The Hayes review of acute services points the way forward for acute hospital care in Northern Ireland. Serious consultation and decisions on the future configuration of hospitals must be a priority for the Assembly.
This problem affects all our people, irrespective of class or creed. It is far too serious an issue for political point-scoring. It is time that the Assembly stood together and got this problem resolved once and for all. This crisis is not acceptable, and the Health Service needs urgent, decisive action. I support the motion.

Mr Maurice Morrow: I too support the motion. The concern being expressed outside conveys the message to us all that all is not well in the Health Service. I suspect that during the Minister’s deliberations she will again remind the House that, in some way, the problem is not of her making. The continual distancing of herself and her Department from the problem washes very lightly with the general public. Whether it is of her making or not, the bottom line is that it is her problem and her responsibility. It is difficult to understand why we seem to be going from one crisis to another. If this were happening in a modern company, something drastic would be done.
One of the most fundamental and basic rights of any individual is access to a good healthcare system. However, it appears that when it is the Health Service, there seems to be a degree of complacency, indifference and, at times, neglect, to say the very least — I am trying to be kind. Some might find those words a bit sharp, but I did not create the perception. The perception out there is that no one seems to really care. It is the Minister’s responsibility to sit down with her officials and work out a resolution to the crisis in our healthcare system.
Every possible index of the state of the Health Service shows one thing; one word could sum it up — deterioration. From waiting lists to the hours worked by junior doctors, there is a continual deterioration. We, as Assembly Members and public representatives, demand to know why it is that way. The Minister continually tells us that the Tories did all this, and that it is of their making. My understanding is that the Tories are long gone, and some even say that they have been forgotten about. Others have made the bold statement that they will never be back. Who are we going to blame then? Has Labour not had a term of office? Has Bairbre de Brún not had a term of office? "No blame at all to me" she says — and, like Pilate, washes her hands.
During direct rule, the cry was always made, "If we had a local Administration, we would make things different. We would make them hum. We would have a Health Service that was second to none, and we would make every citizen proud of the fact that local people had their hands on the local issues." Is that happening today?

Mr Peter Weir: To be fair, would the Member not agree that the situation is different? Since the Minister took over, things have got worse.

Mr Maurice Morrow: Sadly, that is true. Things are steadily getting worse, and soon they will be out of control. Without the professionalism of the doctors, the nurses — and the ancillary staff, I hasten to add — there would be chaos. The Department’s managers and the Minister must take note. They cannot continually stand up like Pilate and say "Not our responsibility. We are not the guilty people."
The Minister has approximately 40% of the block grant at her disposal. She may say that that is not enough, and that may be true in some cases. However, if the Minister had enough money tomorrow, would she have a blueprint and a plan to put before the Assembly, the doctors and, more importantly, the patients in Northern Ireland? Has she got that blueprint to demonstrate in unambiguous terms that she is in charge of the situation? She will have to do better than she has been doing, because she convinces nobody. Whether or not the situation is of her making, she must stand up and say "Look, this is my job. This is my responsibility. I am concerned."
The Minister’s continued running away from the crisis in her Health Service will not wash any longer. It may be a nice, convenient fig leaf to hide behind to say that the problem is somebody else’s. It is the Minister’s problem. She may not want it, and Mr John Kelly argued that anybody else could have had the Health portfolio. Well, nobody else has it. His party has it. He then boldly said that his party are socialists, yet they leave patients lying in wards, on trolleys and in corridors.
If the Conservatives did that, I hasten to add, those socialists would be standing outside every hospital with their placards. However, they are not doing that, because the birds have come home to roost, and now that it is their responsibility they do not like it one little bit. They do not like criticism, but a Minister should not be so gutless as to be unable to take criticism. Let the Minister stand up and take the criticism, and never mind the yobbo behind her who seems to be more interested in going down for a political rant. Some of us are very sincere about this.
I recently visited Craigavon Area Hospital at the invitation of Dr Maguire, and I saw at first hand what was happening there. When the Minister and her officials decided to close South Tyrone Hospital, they were warned that Craigavon Area Hospital could not cope, because it was already at 90% capacity. What were we told? "You do not know what you are talking about. We can cope. We can sort it." Are they sorting it? Tragically, they are not. Patients are being left for hours on end simply because of the overload that has come as a result of the closure of South Tyrone Hospital.
I ask the Minister to retrace her steps, reopen South Tyrone Hospital, especially given the current crisis. Let her demonstrate that she does care and that she is concerned. Then she will start to convince people that she has the stomach for the job that she is in.

Mr Tommy Gallagher: I welcome the opportunity to discuss the recent health crisis. The public, who have witnessed the dreadful scenes in our hospitals in recent weeks and years want to see and hear about solutions. That also goes for the patients whom we saw on trolleys, for their distressed families — some of whom we saw interviewed — and for the harassed doctors, nurses and other health workers involved. The public do not wish to see an acrimonious debate in the Chamber, or attempts by individuals or parties to push around the blame.
The public know that there is a solution. They know that what needs fixing comes down to two issues — funding and management. It is as simple as that. As I said yesterday, in the past decade we have lost out in comparison to Britain by around £30 million or £33 million a year, yet its Health Service is in a beleaguered state. We must bear that in mind and figure out where we stand.
The funding issue requires a three-pronged approach. First, as has been pointed out, this Assembly must press the Treasury to make up some of the funding shortfall. Secondly, our Executive must take on board our key service’s priorities. At that level, additional money has been set aside for health and, already this year, approximately an extra £20 million has been directed towards our Health Service. It is encouraging to see that the Executive have some recognition of the problem.
Thirdly, the Committee for Health, Social Services and Public Safety — and I am sure that other members of that Committee agree with me — relies on the Minister to make the case for more funding. We support the Minister. When we receive correspondence from the Committee for Finance and Personnel, we make our case. When we receive officials from the Department of Health, Social Services and Public Safety, we make the case again.
The other issue concerns management. Everyone knows that executives in the Health Service are highly paid, and some are not doing a good job. We have seen that they are repeating past mistakes. In the light of the scenes that we witnessed in recent weeks, it is time that they were brought into line. That is an issue for the Minister and her Department, and it is one on which I wish to see action taken.
General planning in the Health Service could also be addressed in the short term. Last week, I visited the South Tyrone Hospital in Dungannon where I saw the empty wards. The accident and emergency department is open nine to five, five days a week. If that service alone were open from nine in the morning until 10 at night, seven days a week, less pressure would be placed on Craigavon Hospital. The public understand that; it is common sense. Our managers must be pulled into line about such issues.
We also need a decision on the Hayes Report so that we can get a plan in place and into people’s heads.
Wide consultation has taken place. An independent and representative body was set up, which consulted in this country and beyond, and made recommendations. I hope that we will not be going into further consultation. The doctors and the hospitals realise that in the meantime, with the uncertainty that is generated, services are falling through the floor. They say that it cannot wait, and I agree.
We heard outside the Chamber that the First Minister and the Deputy First Minister, through their offices, refused to meet the Committee for Health, Social Services and Public Safety and that that has something to do with this problem. I do not agree with that view. There are lines of procedure: we have the Committee, the Minister, and the Office of the First Minister and the Deputy First Minister, and we should abide by those lines. Members of the Health Committee back the Minister of Health, Social Services and Public Safety in making her case, and the Committee expects the Minister to argue that case at Executive level.
I will not argue that the Committee should bypass the Minister and go directly to the First Minister or the Deputy First Minister when it suits it. Regardless of what Committee I am on — [Interruption].

Mr Ian Paisley Jnr: Will the Member give way?

Mr Tommy Gallagher: I will not give way. To bypass the Minister is to undermine her. I do not understand why I am hearing that argument from individuals who belong to the Minister’s party, and I would like that matter clarified. Do they want to bypass their own Minister or do they not?

Ms Sue Ramsey: Will the Member give way?

Mr Tommy Gallagher: I will not give way. I have outlined how we should approach the issues of funding and management clearly and consistently.

Mr John Kelly: On a point of order, Mr Deputy Speaker. Did the Member support the call for the First Minister and Deputy First Minister to meet with the Health Committee?

Mr Tommy Gallagher: I supported the Chairperson’s exploration of that concept, and I am on record in the Committee as doing so.
We have an Assembly that people have long sought, and there are procedures and ways of doing business. Let us all get behind those who are in key positions. We all have a responsibility to the public to deliver a proper and efficient Health Service and one that serves them well.

Mr Alan McFarland: We have heard a fair old tale of woe from around the Chamber. The Department must know by now that there is a crisis. The difficulty is that I cannot envisage action of any great detail to sort out the problems. Does the Department know where the choke points are? Where are the problems in the Health Service? On the one hand, £2·5 billion is going in at the top end, and on the other, patients on trolleys and overworked staff exist at the sharp end. That would indicate to any objective observer that something is wrong.
The Health Committee tried to find out where the problems are. It examined the Health Service accounts to try to identify where the money was going and to track it down through the system. That was not possible. It tried to follow the audit trail, but, sure enough, the moment it got there the Department changed the headings, so it was impossible to identify where the money coming in at the top had worked itself out at the bottom. That remains to be the case.
If this were a commercial business, the managing director and the board of directors would have been sacked long ago. In its lack of clear action to deal with the problem, the Department reminds me of the old Soviet politburo, which was unwilling to countenance any change to, or any interference in, its affairs. It will review, consult, consult again, but do nothing.
The Department has a very bad relationship with the Committee for Health, Social Services and Public Safety. It has been an unhelpful and reluctant colleague, unlike many other Departments’ relationships with Assembly Committees. It has adopted an arrogant attitude towards the Assembly. Members will have noticed the concern expressed in a recent report by the Public Accounts Committee about a reply it received from the Department of Health. In its reply to a comment made by the Public Accounts Committee that highlighted a departmental wrongdoing, the Department stated that it did not accept the comments. That Committee is the most powerful one in the Assembly. My colleagues in the Committee for Health, Social Services and Public Safety will bear that out.
We need to re-examine the present situation. Let us look at primary care. The Committee Chairperson talked about the looming chaos, and why, last year, we gave the Minister and the Department a year’s grace to sort itself out and to ease in a better, simpler GP fundholding system. There has not been a dicky bird. There has been no movement, and what was brought before us last year has reappeared. I am concerned about the Department’s attitude.
We have heard about patients waiting on trolleys in hospitals. The Hayes Report stated that 80% of patients in accident and emergency departments should not be there; they would be better dealt with in a primary care situation. Those who live near hospitals use them like a medical centre. We have known that for a long time. What action has been taken to clear the primary care patients out of hospitals, where they are gumming up the works, to allow the hospitals to function properly? There has been no mention of it at all. We heard yesterday about the amazing state of affairs in community care, which is gumming up hospitals from the other end.
Staff on the ground will say privately that the problem is as much a management one as it is a financial one. Health Service staff know where the problems lie, but they are not allowed to initiate change. They fear for their jobs and the system above them that will not countenance change. They are not empowered to implement changes that they know would improve the hospitals.
The Department of Health and the hospital managers need to remind themselves of the purpose of the Health Service. It is not an employment agency, nor is it a system that sits still. It is there for the benefit of patients. However, the patients will say that they do not believe that the present system works for their benefit. That cannot be right. We need leadership from the Department and the Minister and better management in the hospitals.
I urge the Minister to lead a drive to slim down bureaucracy in the boards and trusts. She must encourage managers to empower their staff to improve the effectiveness and efficiency of our hospitals. Then, perhaps, if the Department can identify where the money that the Assembly directs into the Health Service is going, we shall be confident that the Department of Health is effective and is hitting the target. I support the motion.

Ms Sue Ramsey: Go raibh maith agat, Mr Deputy Speaker.

Sir John Gorman: I find it a little difficult to hear you, Ms Ramsey. Will you speak towards the Chair?

Ms Sue Ramsey: John Kelly started the debate as a consultant, but I am only a junior doctor. I will not take a hard run at him.
The most recent Assembly motion, as amended, on the Health Service urged the Minister of Health, Social Services and Public Safety
"to take urgent action to tackle the current crisis in the Health Service, particularly in view of impending additional winter pressures, and calls on the Executive to make the necessary resources available to alleviate pressures throughout the Health Service." — [Official Report, Bound Volume 13, p387].
That debate took place on 11 December 2001; it was the last debate before the Christmas recess. My Colleague John Kelly and I tabled an amendment to that motion calling on the Executive to provide additional money. We are both aware that there are pressures not only on the acute sector but throughout the Health Service — from community care to mental health, from services for the elderly to those for young people. We discussed the situation during the debate on 11 December 2001 and in a debate on care in the community on 21 January 2002. On 11 December 2001 all parties agreed to call on the Executive to provide additional money to target pressures in the service as a whole.
It is regrettable that Tommy Gallagher has just left the Chamber, because he sought clarification on a point. The Committee for Health, Social Services and Public Safety wrote to the Office of the First Minister and the Deputy First Minister on 16 November 2001 because it was aware that we would face a crisis in the service — in dealing with winter pressures, et cetera. We requested a meeting to discuss the years of underfunding of the service. Mr Gallagher states that he agrees with the decision by the Office of the First Minister and the Deputy First Minister not to meet with the Committee because he would see that as sidestepping, or bypassing, the Minister. However, the Minister wrote to the Committee to welcome its approach, because Committee members were going to support her bids. The Committee was visiting hospitals, and it witnessed the problems there. Its intention was to support the Minister’s bids to the Executive.
I hope that Mr Gallagher reads my clarification in the Official Report. In my view the SDLP has now pulled back because the Office of the First Minister and the Deputy First Minister does not want to meet with the Committee. Who is playing politics now?
The Chairperson of the Committee wrote to the other Ministers about the problems faced by the Health Service. One of the proposers of today’s motion, Rev Dr Ian Paisley, is the Chairperson of the Committee for Agriculture and Rural Development. Following on from Dr Hendron’s letter, would Rev Dr Ian Paisley and his Committee allow some of its Department’s budget to go towards alleviating some of the serious problems in the Health Service? It would be silly not to welcome the additional money that has been given to the health sector. However, it is non-recurrent funding.
The Minister of Finance and Personnel today stated that the health sector faces real problems. Some Members said that health is one of the most talked about topics in the Assembly. However, the Department received a less than 10% increase in its budget in the December monitoring round. I must stress that that money is non-recurrent. One cannot talk about a three-, five-, or 10-year plan when the money received is only year-on- year and is non-recurrent.
The Minister of Finance and Personnel also said that many people will ask why the Executive are not doing more to target funding in the Health Service. I want to ask that question. We are aware that there is a serious underfunding of the service. Health is a priority in the Programme for Government, but where is that priority when the Executive are talking about money?
As a member of the Committee for Health, Social Services and Public Safety, I am aware of the problems faced by people working in the front line. I send my thanks to them, because they sometimes work in serious conditions. Last week we visited the Downe Hospital, where there are such problems. Staff there do a brilliant job, and we must congratulate them.
I have spoken to several people in the community sector who are concerned that money will be transferred from their funds to support acute services. The acute sector gets the big headlines. The community sector states that that has happened before, that we need to get away from it and that we must take a holistic approach to health rather than taking money away from one part of the service to give to another.
I make no bones about talking about the years of underfunding. Members have stated several times that this is not a funding issue, yet they proceed to attack the Minister. However, they rightly highlight the problems faced in their constituencies: occupational therapy issues; people not getting community-care packages; and people not being able to get access to wheelchairs. Members need to be aware that the funding of trusts is an issue.
Several Members mentioned waiting lists, an issue that I raised during the debate on 11 December 2001. The Committee for Health, Social Services and Public Safety looked into non-attendance for hospital appointments, because a percentage of patients do not attend appointments. Waiting lists are growing, so we must ensure that people who have appointments keep them — otherwise they are just extending the lists.
What have the Executive done since the motion on the Health Service crisis was passed on 11 December 2001?
Some Members said that we cannot go on blaming the Tories, who have been out of power for the past five years. When they were in power, the Tories stole £190 million a year from the Health Service — a service that they were against from the start. New Labour are not doing any better, because it is giving us the crumbs from the table while investing in the Health Service in England.

Sir John Gorman: Ms Ramsey, thank you for making yourself much more audible to my old ears.

Mr Ian Paisley Jnr: While there are many uncertainties in the Chamber, there are some certainties; one is the way in which some Members react when they are chided. John Kelly is a case in point, given his reaction to crucial health issues raised by my Colleague Mrs Iris Robinson and by Dr Hendron, Mr McFarland and Rev Robert Coulter. One certainty is that when the bait is put into the water, John Kelly always bites. However, he made some interesting points, which are worth repeating and studying when we get the Official Report. He said that the Minister’s political position is the problem — those are his words, not mine. Now that there is a realisation of the problem, perhaps they should do something about it. He is the only person in today’s debate who has said that he did not want it to take place because it is a recycled one. All that the Member has to do —

Mr John Kelly: On a point of order, Mr Deputy Speaker. I said that the problem with the Minister was the DUP’s problem; not the Minister’s problem.

Mr Ian Paisley Jnr: Hansard will show who is being accurate, Mr Deputy Speaker.

Sir John Gorman: We have a serious subject here, and it would be nice if both parties would just get on with that.

Mr Ian Paisley Jnr: Mr Deputy Speaker, you have touched on another certainty about what will and will not happen in the Chamber. Nonetheless, the statement was made that the issue is being recycled. It is clear that if one goes into the wards in Northern Ireland, as many have done, and speaks to patients, relatives, medical, nursing and auxiliary staff, one will find that the problem is not being recycled; it is being renewed every day. It is being repeated in hospitals up, down and across Northern Ireland.
This blindness, this Pontius Pilate-like washing of the hands of blame is completely unacceptable. For a short period during the debate it appeared that the Minister had, for the want of another word, the moral support of the President of IRA/Sinn Féin standing behind her, but as the debate went on, he abandoned the ship, which appears to be sinking.
Two weeks ago, I had the privilege of shadowing Dr Peter Maguire of the BMA in the Craigavon Area Hospital for ten and a half hours of his 22-hour shift. The invitation to accompany Dr Maguire was extended to the Minister, and I had to accept it, although the Minister should have been there to see the problems at first hand. It appears that the Minister could not look the medical, nursing and auxiliary staff, and the patients and visitors to the hospital, in the eye and tell them that her policies were working. I saw a Health Service not in crisis, but, in the words of Dr Maguire, in "meltdown". People have been running away from that reality, and a holier-than-thou attitude of blaming everyone else is no good. The Health Service is staying together only because the tireless efforts by its staff are holding it together by the seams. Sooner or later that could give way.
Mrs Iris Robinson stated that the Minister should have visited Craigavon Area Hospital, because she should be aware of the situation there. I will remind the House of some of the things she would have seen, had she accepted the invitation. She would have witnessed stressed medical staff, overworked nursing staff, no beds available for patients and patients eligible for care in the community blocking beds. The Minister would have seen people giving their all to the Health Service and being given very little in return. She would have seen agency nurses willing to work as full-time members of staff but not being allowed to do so. In the intensive care ward I witnessed the sad reality of the lack of resources when one person was taken from an intensive care bed, put into a medical chair and told that he would have to be treated from there because the intensive care bed was required for a more urgent case. The patient was given a brass bell and told to ring it when he needed nursing attention.
The Health Service has been brought to that Victorian state, and the Department is blind to that reality. I saw patients with nowhere to go, their dignity violated by a lack of privacy. I saw a public toilet being used as a ward toilet by patients assigned to trolleys in the corridors. I saw staff having to work their socks off in overcrowded conditions, where the movement of patients became an obstacle course along corridors. One emergency theatre had been turned into a makeshift ward. Perhaps the Minister could not look them in the eye and tell them that her policy was working, because it was not working then.
I am sick of hearing the old excuse — let us blame the Tories. That does not wash anymore. The responsibility is here, and we must ask where the allocated money is going. Each time money has been made available Members of the House have voted more and more resources to the Health Service — up to 40% of the block grant. Is the money not traceable once it goes to the Health Service, or is its impact not delivering the desired result? It is not a question of finance at that point, as some Members seem to think — it is a question of management. Management does not start at the bottom; it starts at the top, with the Minister, where it has failed.
Carmel Hanna, who has now become a Minister herself, said in the ‘Belfast Telegraph’ that it is no longer possible to blame London for the problems, and I think that that is absolutely right, but you do not have to take a politician’s word for it. Take the word of the ‘Health Service Journal’.
It said that more money is needed. However, it is not the money that counts; it is the bureaucracy. In fact, it said that the management of the service is escalating the crisis. The ‘Belfast Telegraph’ article said that there was no point in blaming London for the crisis, because it is a crisis of local management.
On 28 December a ‘News Letter’ article said that doctors and GPs were calling on the Minister to either do her job or quit. Those people are not members of the DUP, the UUP or the SDLP; they are health professionals. When those people make such remarks, it is time for the Department to buck itself up or else be put out. Until people realise that, the problem will go beyond meltdown.
When the Assembly votes money to health — before Christmas it voted an extra £8 million for waiting lists — it does not appear to have any effect. Many Members have suggested prescription and improvements. However, people must realise that the Minister has failed. The Office of the First Minster and the Deputy First Minister must recognise that when it is invited to examine a crisis, whether it be foot-and-mouth disease or the problems at Holy Cross Primary School, it has a responsibility to let the people who are up to the job take over and sort the problem out.

Mrs Annie Courtney: The Health Service faces a crisis of confidence. Every day we hear hardship stories of patients waiting for much-needed surgery. Despite the extra funding since devolution, the situation has deteriorated. For example, the number of patients waiting 18 months or more for elective treatment has jumped by about 700% in four years. Since March 1996, the number of people waiting for outpatient appointments has risen from 59,000 to over 128,000. The total number of people waiting for a hospital bed has risen by almost 10% in the last year. Trusts’ deficits more than doubled between 1998-99 and 1999-2000. All that happened despite extra resources.
A 7·2% increase in the budget was announced in October 2000; £17 million was allocated in November 2000; £14·5 million was allocated in January 2001; and £18 million was allocated in February 2001. The budget for 2002-03 will be 37% greater than it was when the Minister took office. That is an increase of £687 million.
The North already spends a higher budget per capita, and a higher percentage of its Budget on acute healthcare than England or the Republic of Ireland. This is proof of the Executive’s and the Assembly’s commitment to the Health Service. However, the Health Service is about management as well as money. Arguments about the lack of resources should not detract from the need to manage the health budget professionally and to deploy resources efficiently. No matter how much we spend on health, we have a responsibility to ensure good management and accountability for how resources are used. Those lying on trolleys because there are no beds need to know that the money is being spent — if not on a bed for them — on something necessary.
It is over seven months since the Department was allocated £18 million to address trusts’ deficits. However, it was not unconditional. The Minister must address the origins and consequences of the deficits. We need answers now. There is concern that some trusts were allowed to run up large deficits, while trusts that managed their budgets well suffered as a consequence. That has nothing to do with the amount of money available to the Department.
In autumn 2000, the framework for action on waiting lists, which was supposed to reduce the waiting list to 48,000, was published, but there is still no report. We need answers to our questions.
Throughout all healthcare facilities there is great disillusionment among staff, including surgeons and medical, nursing, ancillary and ambulance staff. Those people are at the forefront of care. The more hardship headlines they see in the ‘Belfast Telegraph’ — such as "Elderly woman’s 22-hour wait on a trolley" — the more concerned they become, because they must explain to the management why patients were waiting on trolleys.
I agree that funding is critical. However, as the Hayes Report states, while problems can be the result of underfunding, they can also be the result of not using resources efficiently and effectively. It is difficult to argue for additional resources for hospital and community health services, against other national and regional priorities, if it cannot be demonstrated that existing resources are being used to best effect by generally accepted levels of comparison. We need decisions on primary care, on acute care and, above all, on the administration structures in the Health Service. Staff are dealing with day-to-day crises, so they cannot, therefore, give the required time to strategic planning. The Department must take the lead if the situation is to be turned around.
Reference has been made today to the violence at Altnagelvin Hospital during the early hours of Sunday morning. A similar incident occurred three months ago. Security was brought in at that time. Obviously it was not completely effective. How and why that violence occurred is part of the problem. We must ask ourselves why it happened. I believe that it is part of the wider deterioration of community structures. But whatever the reason is, the Assembly needs to take action. We need extra resources for the security that is necessary, if there is not to be a complete breakdown of staff morale. It has got to the stage where the Royal College of Nursing, which is not a militant organisation, is calling for strike action. There is a meeting in Altnagelvin Hospital this evening to discuss the possibility. The call for strike action is the ultimate weapon against the lack of staff security. The matter is critical, and I ask the Minister to make extra funding for the security that Altnagelvin requires a priority.
The Department of Health, Social Services and Public Safety has been allocated an extra £7·8 million in today’s December monitoring round. That is in addition to the £8 million that was announced on 3 December 2001. I recognise that there are many demands, such as junior doctors’ contracts and consultants’ payments, and that there are other pressure such as laboratories, pharmacies and domiciliary care. However, a safe working environment is critical to delivering care. For that reason I ask the Minister to address that problem as a matter of urgency.
Next year’s health spending will be some £224 million pounds more than the current year’s. However, we must ensure that that money is used to the greatest possible effect — we want staff in accident and emergency departments to feel secure in their work and patients requiring treatment to come into a safe environment. This morning the Minister of Finance and Personnel stated that his Department is to carry out a needs and effectiveness evaluation. That evaluation is necessary to enable us to understand what we are achieving with what we are spending. The Assembly must restore confidence in the Health Service. In becoming a member of the Health Committee, I hope that I can work constructively for the betterment of the Health Service.

Sir John Gorman: There are only a couple of Members left to speak. Please use the time as well as possible, and do not repeat what has already been said.

Mr Barry McElduff: Go raibh maith agat, a LeasCheann Comhairle. I do not plan to speak for an hour.
I acknowledge the tremendous difficulties in the Health Service. I also acknowledge the Minister’s best efforts to get to grips with, and to plan beyond, the difficulties that she has inherited. I want to add my voice to the call for greater funding for the Health Service — in recognition of, and in response to, historic underfunding. Members agree that it must become the number one priority for the Assembly and the Executive. We must put differences aside in the interest of providing a proper Health Service for everyone’s benefit.
To depart from normal practice, I commend Mr Paisley Jnr for his initiative in visiting Craigavon Area Hospital. However, how much more powerful would that initiative have been if he had persuaded his Colleagues, Minister Robinson and Minister Dodds, to sit around the Executive table and add weight to the argument for more funding for the Health Service. That would be more meaningful and would deliver more in the long term.
It is rich to hear a lecture from the Democratic Unionist Party on the Health Service when that party ducked choosing the Department of Health, Social Services and Public Safety when it could have taken it. Sinn Féin had the courage to go for it — in the person of Bairbre de Brún.
The Barnett formula must be reviewed, with the objective of introducing a system that will address years of chronic underfunding. I speak from the perspective of Fermanagh and Tyrone. The Minister has met delegations from many hospitals and campaign groups that expressed people’s concerns and fears about the Hayes review — not least from the two counties that I mentioned. I ask the Minister to ensure the maintenance, where possible, of existing services at both the Tyrone County Hospital and the Erne Hospital, and the expansion of services where necessary. People in Fermanagh and Tyrone fear a running down and destabilising of existing services in such a way that one might easily slip over to the other. I ask for a bridge to the future to be built with regard to both those hospitals. I also ask the Minister to listen to the consultants and various campaigners whom she met recently.

Sir John Gorman: You were very frugal with the amount of time that you used, Mr McElduff. I appreciate that.

Prof Monica McWilliams: It is probably significant that we have debated the Health Service today and yesterday. It is something of a shame that both motions could not have been combined, as they are very much interrelated.
The public no longer want to see the blame game being played — they want to see some action. I want to hear proposals from both the Minister and the Member winding up the debate to solve the problems. I have listened to much of the debate, and it has been disproportionately heavy on blame. Previous Governments have been blamed; not just the Conservatives, but also the current Labour Government, who seem to be investing as little as their predecessors. The Minister has been blamed, as have other Ministers and the Executive as a whole. Proposals must come out of the Assembly, otherwise motions such as this will continue to be debated.
I was worried to hear that medical negligence cases cost £27 million. That figure may go up, not down, if we do not start to tackle the crisis. I have received many letters, as other Members have, from consultants. We have previously mentioned, as has the Chairperson of the Committee for Health, Social Services and Public Safety, cases where patients have been passed through accident and emergency departments straight on to wards, where they are assessed for trauma. That happens because hospitals do not have the specialised or nursing staff in accident and emergency departments to do that. That is extremely dangerous and will increase the number of negligence cases in the future. If we are to save money, instead of currently pouring money in to prevent more of those problems arising, plans must be put in place.
I was concerned to hear the Minister state yesterday that five sixths of all spending will go on existing services. That leaves one sixth for very little else. We must turn those figures around. I do not want to repeat what I said yesterday about the need to reorientate the culture of how health services are delivered. We must think about delivering intensive and acute care to communities.
We have highly qualified and educated health and social services staff who are ready and waiting to do that. Most staff want to work within their communities. We must start to deliver intensive therapies and care in the communities. Other countries have proved that it can be done, as have some trusts here. I want to ask the Minister why, having looked at what services the trusts are providing, there is such variation in their plans. Some trusts are simply sending patients to be institutionalised and dealt with in hospitals, while others are beginning to introduce innovative plans to prevent bed blocking from starting in the first place. Equally, other trusts are trying to discharge patients more quickly. There is a notion that patients are moved out of hospitals quicker and sicker, but it has been proved that that is occurring less in Northern Ireland than elsewhere and that Northern Ireland is more able to cope with it.
We ought to look at plans of that kind. Yes, infections are increasing, and at the latest update 156 beds were out of use, but we should be able to predict other things. Infections are unpredictable, but most of what we are dealing with in the Health Service is predictable. It is time to reorient it and put those plans in place. Let us not wait for reorganisation; let us put that plan and those proposals in place now.
This morning we debated our December monitoring round, and I am very concerned. There is no such thing as a "Department of the Centre", yet it appears in the monitoring return. I asked that question over and over again. If it means the Executive, then that should be clearly stated. If the Executive say that they are holding back £40 million for a rainy day, why was only £8 million of that given to the Health Service? Of that, £3·4 million went on medical equipment.
At the moment we are hearing about staff shortages. Annie Courtney said that not only is staff morale being sapped, but that now staff are being attacked for their inability to get on with their jobs. Real safety precautions must be put in place to stop that. In addressing the recruitment and retention of staff, we must build up their morale.
Unfortunately, staffing has now become so dependent on agency staff that the permanent nursing staff are demoralised. Agency staff should not constantly be relied upon to make up the shortfall. I understand that the permanent nursing staff have been reduced by 43% since 1998. Something must be done about that. I understand that medical staff have not been cut in the same way, but clearly that must be addressed.
I am often concerned in discussions about hospitals, but if there has to be a bit of firefighting, we must also look at how we can prevent problems arising around mental illness, physical disability and learning disability. Sue Ramsey quite rightly said that money is constantly being taken from those services to deal with the problems in the hospitals. Those problems are genuine.
Concerning cancer, if the Health Service strike is discussed today, it is only fair that we should know what will happen with regard to all those patients with cancer who look for information about the new cancer unit on the Belfast City Hospital site. Also, I have just heard that once again the neonatal unit at the Royal Victoria Hospital has been closed to outside admissions. With 5,000 births in that hospital and 500 in the Downpatrick Maternity Hospital, we knew that a plan for a new centralised maternity hospital was needed.
The issues of cost effectiveness and cost efficiencies really must be taken seriously. A huge number of highly paid consultants sit around most of the time doing very little. Again, that service could perhaps be reoriented towards a midwife-led unit.
Those very difficult decisions clearly will have to be taken. To close the regional neonatal unit for the intensive care of babies to outside admissions is a very dangerous thing to do, and it clearly causes concern. I suggest that the Executive examine the reorientation of some of the moneys that were surrendered. Out of £40 million surrendered, only £8 million came out, and £3·4 million of that went on equipment. That left a very small sum of money — only £4·6 million — for the issues of staffing shortages and pressures. Those messages should not go out to disillusion people. There is £40 million, and the Executive must take it seriously. It is not only a matter of resources. It is also an issue of management, co-ordination and planning.

Mr Peter Weir: To pick up on a point raised by Ms McWilliams, I must first express disappointment about cancer services. As late as yesterday, in a written question, I asked the Department for a date on which the cancer unit would be operational. The Department is still not in a position to provide that date. We need both certainty and swift action to ensure that people are cared for.
Today’s debate is vital; it is difficult to find an issue that is more important to the people of Northern Ireland. Without indulging too much in the blame game, having been present for most of the debate, I am somewhat disappointed that so few Members have attended.
Suppose that a family doctor diagnoses that his or her patient needs an operation. That person is asked which day of the following week would suit for the operation. A telephone call is made to the hospital, and the arrangements are made for the operation to be performed the following week. That scenario seems extremely unrealistic; in fact, it would appear surreal to many people in Northern Ireland. However, it is commonplace in many parts of western Europe.
In the long term, it is not simply a question of funding. Although I support the calls for greater pressure to be put on the Exchequer to bring Northern Ireland into line with the rest of the United Kingdom, we must realise that, as a whole, the United Kingdom has, for many years, lagged behind the general standards in western Europe. The level of gross domestic product that has been spent on health issues is well below the European average. Therefore, it is not simply a question of bringing Northern Ireland up to United Kingdom levels.
There has either been a deliberate misunderstanding or an attempt by some Members to suggest that the motion is not about funding. No one has suggested that additional funding is not required for the Health Service. However, time and time again, Members have correctly said that it is not simply a question of funding. It may not be, but funding is crucial to the allocation of resources.
The Department and the Minister must accept their fair share of the blame. It is not simply a question of the Minister’s inadequacies; the crisis has also come about as a result of the apparently unaltered managerial ethos in the Department of Health, Social Services and Public Safety. At worst, change is regarded as something to be delayed and, at best, as something to be avoided altogether. One wonders whether that Department treats original thought with the same contempt that a minister would treat the concept of original sin. It seems that there is a resistance to change in the Department.
Although we are all agreed that we want to realise clichés such as pulling together and not treating health as a political issue, much of the blame must rest with the Minister and the Department. We need a Minister who will provide action, rather than consultations alone; we need a Minister who will deliver to the coalface of medicine, rather than produce yet another review.
Several issues must be tackled. If, as was indicated, the preponderance of health boards and trusts needs to be streamlined urgently, one would hope that the Department would adopt a proactive approach and devise its own proposals. However, if it is either unwilling or unable to do so, the Executive must fast-track the review of public administration. I appreciate that a review of public administration is ongoing, but priority must be given to the health issues to ensure that results are delivered as soon as possible.
As was indicated by the Chairperson of the Health Committee and others, including Mr McCarthy, the issues of primary care and care in the community must be tackled. They are the key to the hospital crisis. Doctors tell us that too many people are unnecessarily admitted to hospital and that people remain in hospitals for too long because there are no beds available in the community. That has a knock-on effect on the waiting lists for acute hospitals and provision. I am not convinced that the proposals will benefit primary care.
That is at the heart of the matter.
(Madam Deputy Speaker [Ms Morrice] in the Chair)
We also need rapid progress on acute hospitals. The Hayes Report states that too many hospitals deal only with acute services, so expertise is spread too thinly. Most doctors accept that that is the case. A better system would concentrate the number of acute hospitals and provide a secondary tier of services at community level. In my town of Bangor, a very good community hospital provides that level of service, thus enabling real medical resources to be put into acute hospitals.
Something must also be done urgently about the disillusionment of healthcare staff. Like others, I pay tribute to them. Unfortunately, to use a phrase that was first used in the first world war, "lions are led by donkeys" in the Health Service. Staff at the lower levels provide excellent care, but they are not given the help that they need from the top. A British Medical Association (BMA) General Practitioners’ Committee recently conducted a survey of GPs’ opinions by sending a questionnaire to every family doctor in the UK. The findings, which were released a few weeks ago, highlight the dissatisfaction with the Health Service and the need to resolve urgently the shortage of GPs. One of the results of the survey shows that four out of every 10 young GPs want to reduce their working hours over the next five years, and most GPs in their twenties intend to retire early. That is a major problem; resources have been put into training people, but too many drop out because of poor morale. That issue must be tackled.
We must make better use of technology. For example, more use of IT would enable medical staff to see, at the touch of a button, what medication a patient was on, what illnesses he or she suffered from and the results of previous investigations. That would save more lives, which is the ultimate test of any Health Service provision.
Ways of screening must be improved to ensure that people who do not need to see a doctor do not use up time. More help could then be given to those who need it. That would also ensure greater mobility and would allow surgeons to spend more time in theatre performing procedures.

Ms Jane Morrice: I ask the Member to draw his remarks to a close.

Mr Peter Weir: The crisis has not been caused simply by a lack of funding; inadequate management has played its part. We need action, not words; we need delivery, not another review or consultation.

Mr Gerry McHugh: Go raibh maith agat, a LeasCheann Comhairle. Few Members from the west have taken part in the debate; I wish to rectify that. Much of the debate has centred on management and on the roles of the Minister and the Committee. This is a long-running debate; it is a regurgitated debate. We are rehashing the same debate time and time again, a debate prompted more by politics than by health.
As I mentioned in yesterday’s debate on community care, there is a history of destruction of the Health Service by the Tory Government, which dates from the 1980s and 1990s. They made cuts of 3% a year, which left us to cope with years of underfunding in community, primary, acute, and accident and emergency care in all Six Counties. The responsibility for health also lies beyond the Department of Health, Social Services and Public Safety: all Departments must make the matter a priority or it will not receive the attention that is needed. Healthcare is very significant, and health problems are probably the worst problems that anyone must face. Health should therefore have priority over other departmental issues. The Department of Education and the Department of Agriculture and Rural Development have a role to play, and, in my part of the country, the state of country roads also affects health.
Health issues have a major impact on family income. There is a high unemployment rate in Fermanagh. Many people are forced to take low-paid jobs, and we have a growing elderly population. All those factors increase the pressure on local hospitals.
Food and diet also have an impact on health. We live in a fast food society, in which children eat a good deal of junk food, and such products are widely advertised. Drinks vending machines are available in schools, which encourages children to have a high-sugar diet. Those factors will have a massive impact on hospitals’ future costs. The effect of pesticides on food is a problem for the Department of Agriculture and Rural Development. I mentioned that yesterday to the Minister of Agriculture and Rural Development, who said that there was nothing wrong with organic or locally produced food. However, I was referring to food that we import, and which is grown using substances that we banned years ago.
Drugs, alcohol abuse and smoking also affect health. Every day, young people watch people smoking on the most popular television shows. Such programmes advertise smoking as if it were going out of fashion — of course, we hope that it will. Government Departments, Ministers and others should lobby to stop such advertisements for smoking, so that young people do not succumb to peer pressure and begin to smoke, as smoking can have a major impact on young people’s future health.
The foot-and-mouth disease crisis and the loss of income in areas such as Armagh and Newry have had an effect by way of stress, depression, suicide rates, help to families and counselling. I raised that issue in yesterday’s debate on community care. Those factors affect health services, because, if patients do not receive early treatment, they may have to go to hospital, which results in very high costs.
Carmel Hanna was quoted earlier as saying that it is no longer possible to blame everything on London. However, London must be blamed for the amount of money that we are allowed to spend here every year. Members, and particularly those in the DUP, seem to be playing politics. This is a handy football for the DUP, which it will use to the best of its ability. Health does not seem to come into it — it is mostly about politics.
Areas such as Fermanagh have fared badly with the recently published document on the Noble index. Departments and Ministers should re-examine that document to see whether it has been rural-proofed and TSN-proofed. We are told that it has been TSN-proofed, but I do not believe that that is the case — it does not stand up to local scrutiny. Perhaps the entire document should be reviewed. If Departments use that document as a baseline — and it would seem that that they do — rural areas will lose out badly.
Responsibility for access to healthcare and acute care services falls under the remit of Peter Robinson and the Department for Regional Development. Roads are very much a part of any debate on the Hayes Review and the reconfiguration of hospitals. In fact, access to services is more important than the hospitals themselves, and that issue must be dealt with. From the recent plans published for roads, it seems that most of the funding will be sucked into the Belfast metropolitan area, while other areas will receive no funding.
Barry McElduff mentioned the Hayes Report, which is vital to the future of hospital configurations in the Six Counties. We must include the border areas in those configurations too. A large geographical area running from Monaghan to Sligo, and including Tyrone, Fermanagh and Cavan, could be left with no acute healthcare services if both sides do not work together to ensure the provision of vital health services.
We need to get value for money from the Hayes review, and it must be implemented. Tyrone and Fermanagh need acute services and primary care — both areas must be looked after, and we need decisions as soon as possible.
I am disturbed that the Committee and the Department are at such extreme odds — or so it seems from this debate. That is not a healthy situation. It is not good for the health of the people, and is not a great way of going forward. They have to find a consensus. Is there enough money? Are we doing the right things? Are we getting it right, and are we going forward in the next number of years to put things right? Go raibh maith agat.

Ms Jane Morrice: There being no further requests to speak — Mr Shannon.

Mr Jim Shannon: Thank you for giving me the opportunity to speak.
This subject concerns us all, irrespective of party or opinion. Each of us is concerned that the Health Service is unable to deliver at present. Many of us have addressed this issue before. Most of us have spoken on it, and we will probably do so again. Yesterday we debated the provision of community care, which is a big issue. I agree with Members who say that there is a clear relationship between both. There is a domino effect — they both work in tandem. Will this debate end without any action being taken, or will steps be taken to address the issue?
Anyone who reads the provincial or local papers before or after Christmas will be aware of specific cases where people have not received the service that they should have done. The Health Service is failing to deliver for them. The demands on the Health Service continue to increase, and the system is crumbling at the edges. Indeed, my Colleague Mr Paisley Jnr said that the Health Service is showing signs of meltdown. That is what we believe to be the seriousness of the situation.
We all have constituents coming each and every day to our advice centres, phoning our homes and speaking to us on the streets. They tell us their horror stories of delays, long waits for operations, and a Health Service that cannot cope.

Rev Dr Ian Paisley: Accusations have been made in this debate that the DUP is being partial. I have a Roman Catholic constituent who has had cancer. She is fortunate that the cancer is in remission, but as a consequence she has bowel trouble. Her GP said that it would be terrible if the cancer came back and referred her to the hospital. She got a card to say that she would be seen in seven months. That is not an isolated case — it goes on and on. As Members of Parliament, and Members of this House, we have a responsibility to those people to highlight their cases.
When one of my Colleagues, Mr Campbell, banned sheep grazing in the Mournes because of cryptosporidium, Members called for his resignation. Now, when these problems are happening in the Health Service, criticism of both the Minister and the Department should be legitimate. We have been told that the Committee and the Department are at loggerheads, so something must be drastically wrong.

Mr Jim Shannon: I thank the leader of my party for his intervention. We all could recount similar cases of people who, irrespective of their affiliation or political opinion, have come to us for help. That is our job as elected representatives.
I pay tribute to the doctors, nurses, and the ancillary staff. They are the unsung heroes who try to do their best in very difficult circumstances.
I want to highlight waiting lists, as they are a good indicator of what is happening. The waiting lists for orthopaedic speciality — not operations, just appointments — are interesting: 1,271 people have been waiting between one and 11 months, while 13,053 people have been waiting between 12 and 24 months or more.
The waiting list for surgery is horrendous. Almost 15,000 people are waiting for general surgery; 1,500 have been waiting for more than 24 months; 629 people are waiting for neurosurgery, 266 for 11 months and 353 for more than 24 months. It goes on and on. Two thousand five hundred people are waiting for plastic surgery, and 549 are waiting for cardiac operations. Almost 50,000 people in the Province are waiting for operations. That is a health system failing to deliver; that is a Department in chaos and disarray.
Things might have been bad a couple of years ago, but they have got worse. In 1999, 14,020 people were waiting for orthopaedic outpatient appointments; today that figure has almost doubled. That should illustrate the situation for those who are in any doubt that we are in crisis.
The Health Service is not doing enough for victims of sexual abuse. I met the chief executive of the Ulster Hospital Community Trust, and I asked him to make extra provision. The money is not there. The Nexus Institute does tremendous work in providing counselling. However, when I asked for extra provision for counselling in my constituency, I was told that the institute would love to do that, because people needed assistance, but that there was no money. There is extra demand on the Health Service, and the service is needed, but it is not being delivered. People need help, but the Department has failed to deliver.
Administration must be revamped. There are 27 trusts and four boards, yet there is talk of introducing another level of administration into the Health Service. We must make changes, and there must be streamlining at that level to make the service more efficient.
With regard to funding for the Health Service, it is time that we took the matter to the highest level, to Westminster. It is time for funding to be made available through the Department and through the Office of the First Minister and the Deputy First Minister. The time is right for a radical approach, with no holds barred. If that does not happen, I am afraid that we shall return to discuss the future of the Health Service while our constituents wait and suffer. I wonder how many of those on the waiting list for urgent operations will be here in a few months or less if they do not get the urgent and positive action that is needed. I support the motion.

Ms Bairbre de Brún: Go raibh maith agat, a LeasCheann Comhairle. Chuir go leor Comhaltaí a n-imní in iúl inniu faoi chúrsaí inár seirbhís otharlainne, agus tá mé féin ar aon aigne leo faoina thábhachtaí atá sé dul go bun na faidhbe seo go héifeachtach.
Tugaim do m’aire go n-aithníonn Comhaltaí brú suntasach a bheith ar ár n-otharlanna agus go háirithe ar an fhoireann atá ag obair iontu. Is mór mo mheas ar obair ár bhfoirne; mhaolaigh a scileanna, a n-oilteacht agus a ndíograis ar iarmhairtí na mbrúnna a bhí ar othair ar na mallaibh.
Ón uair a ceapadh i m’Aire mé, tharraing mé aird ar na brúnna troma atá ar ár n-otharlanna agus ar ár seirbhísí cúraim phobail; d’áitigh mé nár cuireadh acmhainní ar fáil do na seirbhísí seo le riar ar na héilimh a dhéantar orthu. Is é fírinne lom an scéil nach bhfuil na hacmhainní acu ná an fhoireann le riar go sásúil ar na héilimh a dhéantar orthu; éilimh atá ag méadú de shíor.
Dhearbhaigh mé ariamh nach mbeidh ár seirbhísí in innimh plé leis na brúnna a luaigh Comhaltaí inniu gan infheistíocht athfhillteach shuntasach thar roinnt blianta.
Le seachtainí agus le míonna beaga anuas, chuir mé béim chomh maith ar an iomad dea-rud atá ag dul ar aghaidh ar fud ár seirbhísí, ainneoin a bhfuil de dheacrachtaí ann le hacmhainniú. Tá dul chun cinn á dhéanamh againn i gcónaí le caighdeán agus éifeacht seirbhísí a fheabhsú; agus níl deireadh ar na torthaí ar an phleanáil a rinne muid lenár gcórais a shruthlíniú agus lenár gcomhoibriú a fheabhsú, go háirithe san uair is treise brú.
Many Members have expressed concern about the situation in our hospital services today. I share their anxiety, and I am equally determined to ensure that the underlying issues are effectively addressed. I note the widespread recognition by Members of the significant pressures on our hospitals, and particularly on the staff who work in them. I have the highest admiration for the work of our staff, whose skill, expertise and commitment have played a vital part in minimising the effects of recent pressures on hospital patients.
Ever since my appointment, I have drawn attention to the heavy pressures on our hospitals and community care services and argued strongly that these services have not been resourced in the past to meet the demands made on them. I welcome the fact that that has been reiterated today by virtually every Member who spoke in the debate. Our community and hospital services simply do not have the capacity or the staffing to handle the continually growing demands that are being made of them.
Despite the removal from the baseline of £190 million in today’s terms since the 1980s and 1990s, the service has treated 10% more patients, and there has been a 27% increase in community care packages. The service has also seen an increase in emergency admissions of almost 10% in the last year. I have maintained that without significant recurring investment over several years, our services will not be able to deal with the pressures that Members have drawn attention to so graphically today.
Over recent weeks and months I have also highlighted the fact that, despite all the problems relating to resourcing, there is still much that is positive happening across our services. We continue to make real progress in improving the quality and effectiveness of services, and our planning to streamline our systems and improve collaboration continues to pay dividends, particularly at times of intense pressure. Colleagues elsewhere have commented favourably on the degree of integration in our services.
With regard to the work and the immediate action that has been taken to address the situation that I faced when taking office, since that day our hospitals have 33 more intensive-care and high-dependency beds, 100 more nurses are entering training every year and more people are receiving community care than ever before. There will be a further 1,000 extra community care packages in the coming year alone, on top of the additional 230 extra this year, and 100 new ambulances are on our roads.
I have also directed additional resources into important areas of hospital services, such as cancer treatment and cardiac surgery. That is only an initial step in the right direction. Local cancer units are now up and running in all our major hospitals, with over 50% of all day-patient chemotherapy now provided outside the main centre in Belfast. We are also making significant progress on the construction of the new cancer centre.
On foot of the recent review of cardiac surgery, I am putting in place measures to get more operations carried out and to deal with unacceptably long waits for treatment. We have carried out convincing work to improve all of those services. I am determined to press for further improvements in the quality of both those vital service areas.
We are also addressing capacity issues through staffing, recruitment, training and the professional development of staff by means of comprehensive health and social services workforce planning. That will have a direct and positive impact on the staffing of hospitals. Those are just some of the building blocks being used to put meat on the bones of our clear vision for high-quality services as resources become available to put the vision into practice. There has also been detailed planning over the short, medium and longer terms. We have the investing for health strategy, the review of acute hospital services, ‘Building the Way Forward in Primary Care’, the review of community care and the implementation of the Northern Ireland Ambulance Service review. Those measures will enable us to take the necessary steps to meet the needs of the service user, while reflecting the potential impact of longer-term drivers for change, such as the age profile of the population and new or emerging medical technologies.
I have already reported to the Assembly on how I am developing that work. I assure Members that my Department and I are committed to working closely and effectively with the Committee. I value and welcome the Committee’s input and support and I will do so in respect of the work that lies ahead. We must work together to make this vision for the future a reality.
Other immediate actions have taken place. I have already mentioned extra nurses, extra ambulances, extra care in the community and extra intensive care and high-dependency beds. On top of that, the Northern Ireland Social Care Council has been established, to develop the work that social workers want done and to improve standards for social workers. There are extra residential childcare places, there is closer integration of the service, and I have put in place financial management arrangements. There have been several forms of immediate action, and yet the self-same Members still stand up during debates and say that a decision must be made. When I make a decision, I am described as "imposing change".
I am working very closely to set up local health and social care groups. Much work has already been undertaken, guidance has been issued, and further guidance will be provided shortly. The Department has been discussing the matter with the British Medical Association and other colleagues. We are setting up these groups to ensure that local people and local health professionals can work together in a multidisciplinary fashion to make local decisions about local services. In addition, this year there has been significant investment in primary care, with an additional £2 million of investment to support the infrastructure of general practice and £2·3 million secured from Executive programme funds to modernise the use of information and communication technology (ICT), as one Member mentioned. The aim of our work is to modernise the use of ICT in general practice over the next three years.
A further £1·5 million for primary care development was devolved to boards, and additional money has been made available to boards this year to meet the cost of setting up the new groups from 1 April 2002. The money currently used to run the GP fundholding scheme, which is tied up in that, and to run the commissioning pilots will be redeployed to finance the new arrangements. That will also allow up to £2·5 million to be diverted from management costs to front- line primary care services. We cannot do that until GP fundholding ends next year. It was unfortunate that we were not able to end that last year. That is on top of the additional resources that I already mentioned.
I join Members in expressing my absolute disgust at the attacks on health and social services staff. The recent attacks in Altnagelvin Hospital have already been mentioned. The Western Health and Social Services Board and Altnagelvin Hospital are discussing specific measures to enhance security at the hospital. I share Members’ concerns about this outrageous attack on vital services, and I know that the trust and the board will give priority to looking at improvements. I will give immediate attention to any proposals that come to me and, while I am attending this debate, my permanent secretary is visiting Altnagelvin Hospital.
With regard to primary care patients, a great deal of action has been taken to provide new GP out-of-hours arrangements to keep people out of hospitals. We also ran a recent advertising campaign to encourage people to get the right treatment, particularly during winter. The Member who raised the point will know of the pilot schemes in Ards Community Hospital and Bangor Community Hospital, which treat many people who would otherwise have gone to the accident and emergency department at the Ulster Hospital. Primary care is central to the way in which our social and health services will work together in the years ahead.
I recognise that the development of the cancer centre is a priority. Work is ongoing at the day-patients’ and outpatients’ wing of the planned cancer facility. That will be completed at the end of 2002 and will be open early next year. The Department of Finance and Personnel has approved a detailed business case for the construction of the new centre, which has been revised to take account of best practice and the latest technology. With the support of the Committee for Health, Social Services and Public Safety, I shall raise that crucial development with Executive Colleagues, with a view to having it included in the next tranche of Executive programme funds. The Committee has discussed the matter with me in the past.
I take the opportunity to outline some of the immediate actions and benefits that have resulted from the framework for action on waiting lists, on which many people have worked so assiduously. The MRI waiting list initiatives that are taking place across all boards, which include the use of mobile scanners, have successfully reduced waiting numbers. In cardiac surgery initiatives, the Northern Health and Social Services Board has secured capacity with Health Care International (HCI) Private Hospital and Ross Hall Hospital in Glasgow for 51 patients. If all those patients undergo surgery before the end of this financial year, the board’s excess waiting list for cardiac operations will be cleared.
The Southern Health and Social Services Board is using a mobile cath lab at Craigavon Area Hospital to treat 20 patients per month. The Western Health and Social Services Board is using the North West Independent Hospital at Ballykelly for orthopaedic and plastic surgery, and the Northern Board has plans to do that also. Some 210 orthopaedic outpatients have been seen in the Southern Board as a result of a waiting list initiative. The Western Board has held additional ophthalmology clinics at Roe Valley Hospital, which had reduced inpatient waiting numbers from 360 to 30 at 19 December 2001, and the average waiting time from two years to six months.
In general surgery, the Mater Hospital and the Downe Hospital will take 50 and 200 patients respectively from other providers by March 2002. We are working continually on the validation of waiting lists and on specific pilot projects on restructuring theatre use and on rheumatology. Down Lisburn Health and Social Services Trust has an acute and community nurse pilot scheme for rheumatology, and it is also making use of an acute and community nurse for chronic pain. Those are just some of the initiatives that are being introduced to address current problems.
I have been monitoring the situation at Craigavon Area Hospital and other hospitals for some time, and I am very aware that staff in Craigavon are working under extreme pressure. I spoke to staff when I visited that hospital, and I have spoken frequently to the chairperson and the chief executive. Departmental officials are also in continual contact with the hospital. The Southern Health and Social Services Board and Craigavon Area Hospital have been working closely together to deal with the increasing pressures on the hospital.
I assure Ian Paisley Jnr that I look doctors, nurses and ancillary workers in the eye daily. I am delighted to hear that he recognises the effects of underfunding on our services, and I hope that he will work with me to fight for better resources to support those hard-pressed staff.
Although much can be done to make effective use of the facilities at the South Tyrone Hospital, it is not currently possible to provide the type of overnight care described. As Members will know, the Royal College of Physicians withdrew training recognition from the hospital in July 2000. That decision, on top of several measures that had been taken in previous years, led to the temporary removal of some services from that site.
The long-term decisions on the future of the hospital will be taken in the context of the acute hospitals review. There are, however, many outpatient clinics and day surgeries, including new clinics for cardiac outpatients, and brain trauma, at South Tyrone Hospital. There is also a doctor-led minor injuries unit, a comprehensive radiology service, inpatient medical geriatric wards, a day hospital for the elderly and a significant professions- allied-to-medicine service. As South Tyrone Hospital cannot provide overnight care of the type described, it could not have been used to help those recovering from major trauma surgery when pressure was being placed on Craigavon Area Hospital. However, the Southern Board and Craigavon Area Hospital Group Trust are working together to determine how more effective use can be made of South Tyrone Hospital. The question that was raised on extending the doctor-led minor injuries provision is currently under investigation as part of those discussions.
Members often talk of the need to approach the Chancellor of the Exchequer to get a fair share of public money. I do not wish — and it would not be right — to stray into the remit of the Finance and Personnel Minister, Dr Seán Farren. However, I fully agree that the Barnett formula is inadequate and defective, and I note that it will be a matter for the Executive to decide how to approach the matter in the future. If five sixths of additional money is spent on the rising costs of existing services, and the rising costs are being driven by developments in England on pay review body recommendations, drug costs, clinical and other professional standards, and we are not receiving the same uplifts as England, the inevitable effect will be an impact on our standards and levels of service here. In spite of getting additional money this year on top of Barnett, the Department of Health, Social Services and Public Safety is faring less well than the provision in England, where all the significant drivers of pay costs originate.
This year our budget is 5·6% higher than the amount spent last year, including one-off non-recurrent moneys that I secured from monitoring rounds. In England the equivalent increase is 9·4%. Those involved there receive a greater amount of recurrent funding which aids them in their longer-term planning. As has been said, there is a distinct difficulty in having to rely on additional in-year moneys, which are welcome, but they are non-recurrent. Therefore they are not suitable for use in addressing recurring difficulties. They are also not useful in employing additional staff or in addressing long-term planning. We need not only significant extra resources, but much more certainty about the level of funding in the future. Therefore, with regard to the December monitoring addition, it is one-off money, and it would not be prudent to use it for recurrent expenditure. The best and only effective way to put back the capacity that we need is to ensure that we have a properly resourced service. I will try my hardest to secure that in the spending review.
Similarly, I have put in place financial management arrangements that ensure that I can track the money. I published my priorities for action in the Programme for Government, which sets out the key priorities for the service. Boards now have to set out their service investment plans and how they intend to deploy their additional resources. Similarly, trusts, in their service delivery plans, have to set out how they will deliver the agenda. The resources that were needed to deliver the priorities listed in the priorities for action have all been ring-fenced this year, and no discretion is allowed for their deployment elsewhere.
Regular progress meetings with boards enable us to keep track of where the money is going and, should boards wish to redeploy some of the ring-fenced funds, they must first get our approval.
I have put in place a complete system to ensure that health and personal social services remain financially stable, including a requirement to pursue robust recovery plans where expenditure exceeds income by more than 0·5% and the requirement to produce contingency plans when in-year deficits are forecast.
However, one of the most significant points has been the moves to remove the internal market, which contributed to the financial problems by imposing significant income risks on the system and having competitive, rather than collaborative, working arrangements. We have now introduced much more collaborative working arrangements between boards and trusts.
Of course, ensuring that care services are adequately funded before new developments are considered is another important point. However, the overall point is that if we can ensure adequate funding for services to begin with, then we can make best use of those services, and of the dynamism, dedication and commitment of our staff.
Reference was made to the additional funds that I have received this year, and questions were asked about what had happened in relation to that. People will know that of that money — allowing for pay and price inflation, as one Member said — there was £41 million available to improve services. That is less than 2% of a £2·25 billion budget. However, within that I have used those resources to achieve, among other things, an increase in the number of high-dependency beds; investment in improving cancer services; the extension of the Sure Start programme for disadvantaged children; an increase in the number of residential childcare places; an increase in the number of community care packages; and the beginning of modernisation of the Ambulance Service’s accident and emergency fleet. Those are vital issues that had to be addressed.
Like many Members, I have talked about the problem of resources, and much of the pressure that pervades our hospital services has its roots in a lack of investment over many years. As I have said, no less than £190 million — in today’s terms — was taken out of health and social services in the 1980s and 1990s. The legacy of that approach has left a massive lack of capacity in staff, in beds, in equipment and in the community. The outcome is that too many people are in hospital who do not need or want to be there. The immediate action and the long-term planning that we are engaged in are intended to provide a service in which that will not be the outcome for our people. There is no way around the present lack of capacity other than by returning capacity to the service. To do that, we need a stable funding platform to support the development and maintenance of all our services.
A properly resourced service is an absolute priority. I welcome the extra funding that has been made available for this year and next. It will help to sustain existing services and facilitate some modest improvements. However, it will be a long haul to remedy the funding failures of the past. In the meantime, the service is working hard with what it has.
In preparing for winter, for example, a great deal of detailed planning went into making sure that services were boosted for the inevitable winter peaks in demand. There are extra hospital beds and nursing home beds available in this winter period, as well as extra community care services. GP and community pharmacist services have been augmented, and there was another successful flu vaccination programme this year. That is evidence of the commitment and dedication of the staff and also of a year’s detailed planning to see what was needed to ensure that winter pressures would be met by a service that had planned for it.
During the recent virus outbreak that resulted in the temporary closure of some beds on top of the winter pressures, staff worked tirelessly to minimise the disruption to patients. Different trusts worked together collaboratively, as we saw with Musgrave Park Hospital and others when the flu virus affected the fracture service in the Royal Victoria Hospital.
Staff deserve our thanks and credit for their efforts over these weeks in containing and controlling the outbreak and in ensuring that no one who needed emergency care was denied it. It is crucial that we give them the support and the resources they need and that we look to the longer-term future of our hospitals. The acute hospitals review will prepare the ground for major and long-overdue modernisation of our hospital services. The resulting discussion at Executive level, the consultation, the equality impact assessment and the final decisions — all to be taken in the course of this year — will set the hospitals’ agenda for some years to come.
I want to build hospital services as part of an overall, fully integrated service that will meet need not only today, but into the future also. That work will require commitment, determination and resourcing. The work that I have begun will bear fruit, and I am determined to see it through. I look forward to Members’ support in building the services that people have every right to expect.

Mr Paul Berry: It has been a delight to sit through the debate and listen to many Members’ concerns in relation to Northern Ireland’s Health Service.
I rubbish the claim that the DUP is being political by tabling such a motion. I stress that we have constituents coming to us from both sides of the community who are raising deep concerns about the healthcare treatment that they or their relatives have been receiving in hospitals across Northern Ireland. It is important for public representatives such as us to highlight those concerns in the Assembly. Health is an important issue, and no matter what colour, creed or religion a person is, if he fears his health is affected or that he has recurring cancer and he is told that he must wait for seven months before seeing a consultant, such as was the case with Dr Paisley’s constituent, such issues should be brought to the Floor of the House. We cannot say "Oh sorry, we cannot raise that because we might be accused of being political." We need to steer away from that and focus on our constituents’ concerns.
Members of the Committee for Health, Social Services and Public Safety tell me that health is one of their constituents’ biggest concerns. Why is that the case? It is because of the state of our Health Service, and it is up to us to highlight that situation.
The majority of Members’ speeches today have been helpful and productive. Dr Hendron mentioned GP fundholding. That issue was raised by GPs last year at the Committee for Health, Social Services and Public Safety. We have lost a golden opportunity to provide a first-class measure in primary care, and we must seize the opportunity we now have to put that right. I trust that the Department will take Dr Hendron’s and other Members’ views and concerns about primary care and the ending of GP fundholding on board.
Rev Robert Coulter stated that Members must not attempt to score points. I agree with that. We have to work for the constituents of Northern Ireland, no matter where they are from. Many people have deep concerns about their health. Rev Robert Coulter discussed the problem of waiting for operations as did my Colleague Mr Shannon, who stated that a patient must first go onto a consultant’s waiting list and then wait for the operation to be scheduled. That waiting time can average out at over a year. That is totally unacceptable. Rev Robert Coulter stated that we must examine the entire Health Service system in Northern Ireland.
It is clear from the debate that although money is important, we must take a close look at the management of the Health Service. I want the Department to tell the Assembly, through the Health Committee, what it intends to do about its management structure and the boards and trusts. I have not yet heard the Department make any proactive suggestions.
Mrs Courtney said that proper management from top to bottom of the structure and on the hospital wards would improve the Health Service. The perception is that there is too much bureaucracy. However, it is up to us to keep highlighting that until the perception is no longer true. Although we need professional management, it must be properly structured.
Rev Robert Coulter said that we must examine doctors’ and consultants’ contracts. He raised concerns about nurses’ training, the morale of medical staff and the stress that they are under. The Health Committee has visited many hospitals and talked to nurses on the wards. They told us of patients waiting on trolleys for beds, but they also told us about the pressure that they are under. Nurses and health professionals must deal with complaints and the anxiety of patients’ relatives all the time, which causes them stress and anxiety. The Department must consider that and deal with it in order to help the nurses’ situation. It requires immediate decisions.
My Colleague Mr Watson commended the hospital staff across Northern Ireland, as Members have often done. In the last debate on the Health Service in Northern Ireland, I said that the service was running on the goodwill of the nurses, doctors and hospital staff. These problems must not be put on the back-burner. As a Member of the Assembly and of the Health Committee, I say that if we must continue to raise the issue of the Health Service, we shall do so. We should raise it at every opportunity, because it is our duty to the people whom we represent and to the nurses and hospital staff.
The problems of Craigavon Area Hospital have made headlines for several weeks. The problems are still there, and we must examine them. Mr Morrow gave us his views on the problems in his constituency, as well as those of Upper Bann and Newry and Armagh. Craigavon Area Hospital and the hospitals in those areas are under pressure because of the closure of the South Tyrone and Banbridge Hospitals. Those closures were bound to have a detrimental effect on the Health Service and on Craigavon Area Hospital. Craigavon was put under pressure by having to cover the services of other constituencies. Mr Morrow called for the reopening of South Tyrone Hospital to provide more services. We must relieve the pressure on Craigavon Area Hospital before it reaches meltdown.
We go from one crisis to another. All our people have the fundamental right to good healthcare. He said that there is a perception in the community that no one cares. Surely this debate shows that someone cares. The debates initiated by Ms Hanna and Mr Gallagher showed that someone cares. It is important that those issues are taken on board. The Assembly has to show the community that it cares.
Time and time again we hear that the Tories created the current problems in the Health Service, yet in today’s headlines we find a problem that was not created by the Tories. During the last three years £27 million has been paid out in medical negligence cases. That is a matter of deep concern. How can the Assembly tell the people of Northern Ireland that it is doing everything it can for the Health Service, when they only have to look at the headline in today’s ‘Belfast Telegraph’ to find that £27 million, which could have been spent on many of the issues that were discussed in the debate today, has been going down the gully? The Health Committee needs to know — at its meeting tomorrow — how that £27 million was wasted and what plans are being put in place to ensure that that never happens again. Whether the sum is £27 million or £100 that should not happen. Something needs to be done about it.
Mr Gallagher went on to say that funding and management are big issues. The high salaries paid to executives also give cause for great concern. He felt that general planning is needed. He referred to the South Tyrone Hospital. Management and funding were the two big issues raised today.
Mr McFarland raised a point that I thought was important. He asked where the £2·5 billion was being spent. He stated rightly that the Committee had tried to examine the health accounts and that it had not been possible at that time. How is that money spent through the system? The Committee needs further briefing on that situation. He also stated that there is a problem with poor relations between the Department and the Committee. Committee members trust that those relations will be mended in the weeks ahead. He also said that there was an arrogant attitude towards the Committee. That must be rectified.
Mr Paisley Jnr talked about the problems that are renewed daily. He mentioned his visit to Craigavon Area Hospital. He said that everyone there is under severe pressure — patients, relatives, nurses and doctors — and that something needs to be done. He said that he thought the Health Service was in meltdown. There is a lack of beds and a lack of resources, and management at the top has failed. That is the perception in the community. It is up to the Department to take all those matters on board and to deal with them effectively now. In future when officials from the Department are being cross- examined and questioned they must have proper answers.
Ms McWilliams made some important points. She wanted to know what proposals were being brought forward. She said that time and time again this subject has been debated in the Chamber and asked what was being done about it. Debates such as this are important. There are Department of Health officials here taking notes of Members’ proposals. It is a way of doing something about the Health Service.
Ms McWilliams also condemned the attacks on health staff across Northern Ireland. The House condemns the attacks on the staff at Altnagelvin Hospital. Those are matters of grave concern. Further attacks on medical staff in hospitals will have an impact on resources. Staff are, quite rightly, calling for measures to deal with the problem. However, the provision of security to allay the anxieties of staff and relatives visiting the hospitals will require more money.
There have been many matters raised in the debate today. In conclusion, more needs to be done regarding the perception of management and about how funding is spent. Also, the Assembly needs to know more about the waste of £27 million through medical negligence. We need answers and action — not reviews, consultation and discussion —to address this crisis.
Question put and agreed to.
Resolved:
That this Assembly calls on the Minister of Health, Social Services and Public Safety to take immediate action to address the health crisis in our hospitals.
Adjourned at 5.00 pm.